Download Standard Precaution and Transmission

Standard Precaution and Transmissionbased Precaution Procedure (Includes
Isolation Requirements)
1.
Purpose
This Procedure outlines the processes required for Standard Precautions & Transmission-based
Precautions and should be implemented by West Coast District Health Board (WCDHB) staff
members having clinical contact. Standard Precautions are designed to minimize the risk of cross
infection between patients and others in the facility, including visitors.
This Procedure also outlines the process for the treating of patients with communicable
diseases/infections by the WCDHB staff members. And includes information to staff that may
have work restrictions, if they come in contact with a communicable disease.
2.
Application
These Procedures are to be followed by all staff throughout WCDHB and is to be applied to all
patient contacts.
3.
Definitions
For the purposes of this Procedure:
Standard Precautions the use of Standard Precautions is the primary strategy for minimizing
the transmission of healthcare- associated infections.
Transmission Based Precautions are recommended when a patient is known to be or is
suspected of being infected or colonized with pathogens which are epidemiologically important
for example antibiotic resistant organisms & those easily spread by contact, airborne or droplet
transmission.
Isolation is taken to mean the treating of patients with communicable disease/infections with
certain processes that prevent the spread of these diseases and infections.
4.
Responsibilities
For the purposes of this Procedure:
Clinical Nurse Specialist Infection Prevention & Control is required to:
- Oversee all aspects of this Procedure
- Monitor the performance of WCDHB staff members in relation to this Procedure;
Staff Members are required to:
- Ensure they abide by the requirements of this Procedure;
- Abide by all WCDHB Infection Control Policy and Procedures;
- Abide by all WCDHB Health and Safety Policy and Procedure.
Standard Precaution and Transmission-based Precaution Procedure
Page 1 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
5. Resources Required
For Standard Precautions this Procedure requires:
i) Disposable gloves
viii) Sharps container
ii) Disposable aprons
ix) Leak proof containers
iii) Masks
x) Bio hazard bag
iv) Gowns- impervious
xi) Presept
v) Protective eyewear
xii) Alcohol Hand Gel
vi) Covered Linen trolley
For the Isolation Procedure this Procedure requires:
i) Dedicated single room with toilet or en-suite
ii) Biohazard rubbish bags
iii) Disposable Tourniquet
iv) Masks
v) Gowns-impervious
vii) Dedicated Sphygmomanometer and Stethoscope
viii)
ix)
x)
xi)
xii)
xiii)
Disposable gloves
Alcohol Hand Gel
Sharps Containers
Locker
Disposable aprons
Covered Linen trolley
6. Standard Precautions and Transmission-based Precaution Process
1.00
Introduction
1.01
Staff members are to assume that all blood and body fluids are potentially infectious.
1.02
Staff members are to apply Standard Precautions outlined in Section 2.00 for all patient
contacts.
1.03
Staff members are to apply Transmission-based Precautions outlined in Section 3.00
for the specified situations or diseases.
2.00
Standard Precautions
2.01
The 5 Moments of Hand Hygiene is performed to reduce the risk of contact
transmission of infectious agents. Hands and other skin surfaces must be washed
immediately with soap and water if they have been contaminated with blood or body
fluids.
2.02
The use of Personal Protective Equipment (PPE) which may include gloves, gowns,
plastic aprons, mask/face shields and eye protection and is to prevent exposure of the
healthcare worker and patients to infectious agents.
2.03
Disposable gloves are to be used when there is a potential for contact with blood or body
fluids, mucus membranes and broken skin. Hand Hygiene is to be performed prior to
and after removal of gloves.
2.04
The use of disposable gloves and adhesive water resistant dressings are to be utilized for
staff with broken skin, dermatitis and abrasions. Otherwise they must refrain from
patient care.
Standard Precaution and Transmission-based Precaution Procedure
Page 2 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
2.05
Gowns must be impervious and fluid resistant. Sterile gowns must be worn for sterile
procedures with aseptic non touch technique.
Disposable aprons and gowns are to be worn to protect the wearer’s clothing and skin
from contamination with blood or body fluids.
2.06
Masks are worn to protect the mucous membranes of the mouth, nose
and pharynx, when there is the potential for blood or body fluids to be splashed or
aerosolized
•
•
•
•
•
Masks must cover the mouth and nose and provide a snug fit.
Are changed when they are moist or soiled.
Held by the strings / loops to remove.
Masks are discarded immediately after use.
N95 (P2) respirators (duckbill masks) are recommended to protect the wearer from
airborne pathogens such as tuberculosis (Transmission Based Precautions are
required). N95 respirators are also recommended for use during bronchoscopy or
autopsy. Staff must be educated in the correct fitting procedure for N95 masks.
2.07
Protective eyewear, goggles, or face shields should be:
• Fluid repellent, close fitting and shielded at the top and sides.
• Worn when blood or body fluids are likely to be splashed or sprayed for example
during surgery, haemodialysis or cleaning instruments.
• Single use eyewear is discarded immediately after use.
• Reusable eyewear or face shields are cleaned after use according to manufacture’s
instructions
2.08
Appropriate handling and disposal of sharps assists in preventing transmission of
blood borne diseases to health care workers. Sharps contaminated with blood or body
fluids must be handled with extreme care. All sharps are to be disposed of immediately
after use into the sharps container. Needles must not be recapped, bent, broken or
manipulated by hand.
2.09
Appropriate handling of waste and linen assists in reducing transmission of infectious
agents. Linen soiled with blood or body fluids is to be handled in a manner that prevents
skin or mucus membrane exposure, contamination of clothing and avoids transfer of
microorganisms to other patients and environments. Linen must be disposed of in the
appropriate linen container and must not be placed on the floor.
2.10
Impervious linen bags with red strip are to be utilised when linen is contaminated with
blood of body fluids.
2.11
Infectious linen is to be double bagged into impervious linen bag with yellow stripe.
2.12
Soiled articles, and furniture soiled with blood and body fluids must be cleaned and
disinfected or discarded as waste.
2.13
Environmental controls, including cleaning and spills management, assist in preventing
transmission of infectious agents from the environment to patients.
Standard Precaution and Transmission-based Precaution Procedure
Page 3 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
Waste contaminated with blood or body fluid must be discarded into an appropriate
container for disposal. Blood and suction waste that is to be incinerated must be
transported in leak proof containers and not placed into rubbish bags. Other waste must
be disposed of down drains that are connected to a sanitary sewer (i.e. Sluice).
A solution of Presept is effective to disinfect work surfaces contaminated by blood or
body fluids.
Before disinfecting an area visible material is removed by forceps and the bulk of the spill
is cleaned with an absorbent material i.e. paper towels. The area is then cleaned with
detergent and water. A solution of hypochlorite solution (1 tablet presept & 500mls
water) is used disinfect area. Appropriate PPE must be worn during these procedures.
2.14
The reprocessing of Reusable Medical Devices (RMD) (equipment and
instruments) & includes appropriate use of disinfectants to prevent patient-to-patient
transmission of infectious agents.
Mouth pieces/resuscitation bags/ventilation devices are to be used instead of mouth to
mouth resuscitation. Reusable instruments containing or contaminated with blood or
body fluids must be transported in leak proof containers to CSSD as per (the Transporting
Contaminated Items to CSSD procedure)
2.15
Specimens are treated as potentially contaminated and are contained in a biohazard bag in
a rigid sided vessel with a leak proof lid for transporting. Please ensure lid is secure before
placing in biohazard bag. Gloves are worn when assisting in specimen collection and the
handling of specimen containers.
2.16
Respiratory hygiene and cough etiquette reduces the risk of transmission of viral
infections. Remember to cover coughs and sneezes, use tissues and perform hand
hygiene.
2.17
Aseptic non-touch technique aims to prevent microorganisms on hands, equipment
and on surfaces being introduced into the patient.
2.18
Accommodation for isolated patients should enable them to receive care of the same
quality as is provided throughout the hospital.
2.19
All staff members must clearly identify the precautions required before entering the
patient’s room.
2.20
All staff members are required to be familiar with isolation techniques and their
responsibilities for implementation.
3.00
Transmission Based Precautions
3.01
Transmission Based Precautions are used in addition to Standard Precautions, where
the suspected or confirmed presence of infectious agents represents an increased risk of
Transmission.
Standard Precaution and Transmission-based Precaution Procedure
Page 4 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
Transmission Based Precautions are selected according to the rick identified and the way
in which the disease is spread.
4.00
Contact Precautions
4.01
The use of Contact Precautions is to prevent the passing of infection (including bacteria
and communicable diseases) to staff members and other patients from infected wounds,
skin and articles by direct or in-direct contact.
4.02
4.03
Contact precautions are to be practiced in the following circumstances:
Anthrax.
Burns / wounds (Major) infected with Staph. Aureus, Group A Strep, Pseudomonas
Aeruginosa or any other pathogenic organism.
•
Cholera.
•
Clostridium difficle
•
Campylobacter
•
Salmonella
•
Disseminating Herpes Zoster.
•
Entercolitis – Staphylococcal.
•
Gas Gangrene (due to Clostridium perfringens) for duration of illness.
•
Hepatitis A.
•
Herpes Simplex.
•
Chicken Pox.
•
Meliodosis - extra pulmonary with draining sinuses, for duration of illness.
•
MRSA (Confirmed or suspected)
•
Pediculosis. (Lice)
•
Puerperal sepsis (Group A strep vaginal discharge).
•
Rabies.
•
Skin infections with Staph Aureus or Group A Strep.
•
Vaccinia.
•
Wound and skin infections with copious uncontained purulent discharge.
•
•
Contact precautions are to be practiced as follows:
Contact Precautions
Criteria
Room
Protective Clothing
- Gown/Apron
- Gloves.
- Glasses.
Hand Washing
Rubbish (including dressings)
Linen
Sharps
Crockery and Cutlery
Laboratory specimens
Visitor Requirement
Transportation of patients
Single room
Application
Worn by persons entering the room.
Disposable.
If potential for eye splash.
Before, during and after all patient care.
Collected within the room, double bagged into yellow bags.
Infectious Linen is double bagged into a white Impervious bag with yellow stripe
Dispose into appropriate sharps container.
Wipe off excess food, and then send to dishwashing in clear plastic bag
Ensure lid closed tight, transport in a biohazard bag, double bag at door
Hand hygiene prior to leaving patients room, restrict visitors, visitors must visit
Isolation patient last and leave hospital directly after visit.
Only if absolutely necessary.
Notify receiving area of nature of disease.
Patient wears long sleeved gown.
Clean linen on wheelchair or stretcher.
Standard Precaution and Transmission-based Precaution Procedure
Page 5 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
Body fluids
Articles
Tourniquet
Sphygmomanometer. &
Stethoscope
Thermometer
Escort wears long sleeved gown.
Clean equipment after use.
Treat all as potentially contaminated.
Clean & disinfect or discard if contaminated.
Disposable.
Ideally Single patient use. After patient discharged wash with soap and water,
and dry. Isowipes can be used if equipment not visibly soiled.
Disposable
5.00
Droplet and Contact Precautions
5.01
The use of Droplet/Contact Precautions is to prevent the transmission of
bacteria/viruses which are spread by direct or indirect contact and by heavily
contaminated articles, or entry by ingestion.
5.02
Droplet/Contact precautions are to be practiced in the following circumstances:
•
Diarrhoea (acute illness with suspected infectious aetiology)
•
Norovirus
•
Influenzae with vomiting & diarrhoea
•
Rotavirus
•
Plague – Bubonic till lesions have produced a negative culture
•
VHF (Lassa fever, Marburg Virus Disease (special conditions apply refer to
Infectious Diseases procedure)
5.03
Droplet & Contact precautions are to be practiced as follows:
Droplet/Contact Precautions
Criteria
Room
Protective Clothing
- Gown/Apron
- Gloves.
- Glasses.
- Mask
Hand Washing
Rubbish (including dressings)
Linen
Sharps
Crockery and Cutlery
Laboratory specimens
Visitor Requirement
Transportation of patients
Body fluids
Articles
Tourniquet
Sphygmomanometer. &
Stethoscope
Thermometer
Single room
Application
Worn by persons entering the room.
Disposable.
If potential for eye splash.
Worn by all persons entering the room.
Before, during and after all patient care.
Collected within the room, double bagged into yellow bags.
Infectious Linen is double bagged into a white Impervious bag with yellow stripe
Dispose into appropriate sharps container.
Wipe off excess food, and then send to dishwashing in clear plastic bag
Ensure lid closed tight, transport in a biohazard bag, double bag at door
Protective clothing, restricted visiting as patient indicates, hand hygiene, ensure
patient last to be visited, leave hospital directly after visit.
Only if absolutely necessary.
Notify receiving area of nature of disease.
Patient wears mask.
Clean linen on wheelchair or stretcher.
Escort wears long sleeved gown & mask.
Clean equipment after use.
Treat all as potentially contaminated.
Clean & disinfect or discard if contaminated.
Disposable.
Ideally Single patient use. After patient discharged wash with soap and water,
and dry. Isowipes can be used if equipment not visibly soiled.
Disposable
Standard Precaution and Transmission-based Precaution Procedure
Page 6 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
6.00
Respiratory Precautions
6.01
Respiratory precautions are undertaken to prevent the transmission of organisms
normally spread by droplets that have been coughed, sneezed or breathed into the
atmosphere.
6.02
There are two levels of respiratory precautions:
i) Droplet precautions
ii) Airborne precautions
6.02
Droplet precautions are to be practiced in the following circumstances:
6.03
Droplet precautions are to be practiced as follows:
•
•
•
•
•
•
•
•
•
•
•
•
•
Adenovirus.
AIDS patients with a chest infection and copious sputum.
Diptheria.
Haemophilus influenza (in children)
Meningococcal Meningitis.
Meningococcemia.
MRSA (confirmed or suspected) with respiratory tract infection
Mumps.
Mycoplasma pneumonia.
Parvovirus.
Pneumonia.
Rubella.
Streptococcal infections.
• Whooping Cough
Droplet Precautions
Criteria
Room
Protective Clothing
- Gown/Apron
- Mask
- Gloves
Handwashing
Rubbish
Linen
Sharps
Crockery and Cutlery
Laboratory Specimens
Visitor Requirements
Transportation of Patient
Body Fluids
Formites & Articles
Application
Single with door closed. Where possible air extraction / filtration systems are
used
Worn when having direct contact with patient or environment
Disposable filter mask (surgical)
Disposable
Before care, after removing protective clothing, and as per the 5 Moments of
hand hygiene during patient care
Double bag, second bag – yellow
Double bag at point of exit into an Impervious linen bag with yellow stripe
Point of use disposal into designated sharps container. Sharps container wiped
over with suitable disinfectant prior to removal from room
Rinsed and sent to dish wash in clear plastic bag
Label sputum and respiratory secretions with high-risk label.
Ensure lid closed tight
Transport in biohazard bag
Hand hygiene prior to leaving patients room
Protective clothing
Restrict Visitors
Visitors must visit isolation patient last and leave Hospital directly after visit.
Wear isolation gown & mask.
Transport only when necessary
Notify receiving area of nature of disease
Treat all blood and body fluids as being potentially contaminated
Disinfect with suitable disinfectant, or discard
Standard Precaution and Transmission-based Precaution Procedure
Page 7 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
6.04
Droplet Precautions apply to any patient known or suspected to be infected with
epidemiologically important pathogens that can be transmitted by infectious droplets.
6.05
Droplets are generated from the source person, primarily during coughing, sneezing or
talking and during the performance of certain procedures such as suctioning and
Bronchoscopy or Gastroscopy.
6.07
Airborne precautions apply to patients known or suspected to be infected with
important pathogens that can be transmitted by the airborne route. These include:
•
•
•
•
•
•
Measles
Tuberculosis
Chicken Pox
MERS-CoV
SARs
New Emerging Influenzae Viral Diseases
6.08
Airborne transmission occurs by the inhalation of airborne droplet nuclei or dust
particles containing the infectious agent.
6.09
Staff who are non-immune to Measles or Chicken Pox should not enter the affected
patient’s room.
6.10
Everyone entering the room of an infected patient must wear a high filtration
disposable mask. (N95)
6.11
Hand hygiene to be performed as per the 5 Moments of hand hygiene and after
removing protective gear on leaving the room.
6.12
Articles contaminated with infective material should be discarded and double bagged
into yellow rubbish bags for incineration, or cleaned and disinfected.
7.00
Acid Fast Bacilli/Tuberculosis (TB) Precautions
7.01
These precautions are for patients with current Pulmonary TB who have a positive
sputum smear or a chest x-ray appearance that strongly suggests current (active) TB.
Laryngeal TB is also included in this category. .
7.03
Mycobacterium disease due to Mycobacterium other than M. Tb and M Bovis (including
mycobacterium disease of the respiratory tract) do not require AFB precautions except
in situations where vulnerable contacts are involved, such as severely
immunocompromised patients.
7.04
With patients infected with Extra Pulmonary TB, gloves must be worn when handling
infected material. Hand washing as per the 5 Moments of Hand Hygiene.
7.05
Patients infected with respiratory TB are to be nursed in airborne isolation. High
filtration masks must be worn while in the room and strict hand washing procedures
observed.
Standard Precaution and Transmission-based Precaution Procedure
Page 8 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
8.
7.06
Articles contaminated with infective material are thoroughly cleaned and disinfected or
discarded for incineration.
7.07
A two-week minimum period (14 days) of isolation is recommended after the start of
the antituberculosis chemotherapy but the attending consultant or physician may
determine the appropriate period of isolation for any individual patient.
7.08
Sputum cultures from patients with smear negative pulmonary TB, take an average 14
days to come culture positive. These patients that have not been treated must be placed
into isolation.
7.09
Suspected sputum smear negative pulmonary TB or suspected TB with no sputum
production patients must be isolated until respiratory secretions have been obtained and
tested.
8.00
Isolation of Children with Tuberculosis
8.01
Children with primary TB in most cases need not be isolated and can be hospitalized in
an open ward if they are receiving chemotherapy.
8.02
Children and adolescents with contagious pulmonary TB require TB precautions until
effective chemotherapy has been started. Once therapy has begun and the sputum
smears show-diminishing numbers of organisms and the cough has diminished, then the
children no longer need to be managed with airborne precautions.
8.03
Family members of a child with TB should also be managed with TB isolation
precautions when visiting the hospital until they are demonstrated not to have infectious
TB.
8.04
Children who are not coughing or producing sputum do not need isolation even if they
have changes on their x-ray. Such children however should be treated as potentially
contagious until discussion with the Consultant and the Microbiologist has deemed the
child not to require isolation.
Isolation Requirements Process
1.00
Introduction
1.01
Isolation must protect the compromised patient from the environment (Protective
Isolation) or prevent the transmission of the infection/disease from one person to
another. The choice of isolation is governed by the infecting organism and mode of
transmission.
1.02
For all items used for transmission based precautions, the clean materials are kept
outside the room, contaminated items kept inside the room.
1.03
Single Room and Ensuite facilities are preferred however; if this is not practicable ward
facilities can be used provided measures are taken to prevent the spread of the
infectious agent to other patients. Toilets/bathrooms/rooms are to be dedicated, or
cleaned and disinfected before subsequent patient use.
Standard Precaution and Transmission-based Precaution Procedure
Page 9 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
1.04
Only necessary items to be taken into the isolation room.
1.05
Soiled linen should be handled with minimal agitation. Infectious Linen is double
bagged into the white impervious bag with yellow strip. The linen runner must be
placed inside the isolation room and covered with a lid or drawer sheet. Linen is double
bagged at point of exit with 2 staff members into the Infectious linen bag (white
impervious with yellow strip)
1.06
The isolation room should not carry unnecessary furniture and all items must be fully
washable.
1.07
Dedicated patient equipment must be cleaned and decontaminated prior to use by other
patients. Equipment returned to CSSD for decontamination is to be placed directly into
a bin or bag and labeled accordingly.
1.08
All items and equipment necessary for maintaining isolation practice should be
contained in a locker at the entrance to the isolation room.
1.09
Isolation Sign on outside of door must be clearly visible to all visitors and staff who
enter
2.00
Isolation Requirement According to Condition
Condition
Agranutocytosis
Amoebic Dysentery
Mode of Spread
NA
Direct /indirect contact
Faecal-oral route
Isolation Type
Protective
Contact
Anthrax
Bacillus anthracis
Cuteneaus/pulmonary
Broncholitis
Direct contact, inhalation
of spores, and from
animal to human
Contact/Droplet, direct /
indirect contact with
respiratory secretions
Ingestion, inhalation of
contaminated animal
products
Contact/Airborne
Duration of Isolation
Until in remission
Duration of illness or until
clearance of parasite for
Health Care Worker
(HCW) and food handlers
Duration of illness
Droplet
Duration of illness
Brucellosis
Burns: Major
(greater than 10% of
body)
Burn: Minor
(lesser than 10% of body)
Campylobacter
Clostridium Difficile
Cryptosporidium
Cytomegalovirus
Diarrhoea –
undiagnosed
Standard Precautions
Protective
Duration of major open
lesions
Protective
Duration of open lesions
Ingestion
Direct / indirect contact.
Faecal-oral route
Faecal
Oral
Contact
Contact
Duration of illness
Duration of illness
Contact, if incontinent
Saliva, urine, cervical
secretions, semen, breast
milk
Faecal; oral route
Standard Precautions
Duration of illness (clear
culture HCW & Food
Handlers)
Duration of illness
Contact/Droplet
Until 48 hours symptom
free
Standard Precaution and Transmission-based Precaution Procedure
Page 10 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
Diphtheria
Droplet / direct contact
with skin lesions.
IP: 2-5 days
Contact /Droplet
E coli 0157
Direct /indirect
Faecal oral route
Contact
Extensive dermatitis –
non-infected (more than
50% of body)
ESBL
Giardia
NA
Contact
Direct & indirect contact
Faecal-oral
Contact Isolation
Standard Precautions
Haemophilus influenza
(type B only)
Hepatitis A
Direct indirect contact
with respiratory secretions
Faecal-oral
IP: 14-42 days
Infectivity: 1 week
Prodromal until after
symptoms develop
Blood & Body fluids
Blood & Body fluids
Blood & Body fluids
(cannot occur without
hepatitis B coinfection)
Ingestion
Airborne, direct / indirect
contact with skin lesions
or exudates.
IP: 10-21 days
Infectivity: 1-2 days prior
to rash and up to 5 days
after rash develops
Contact/droplet
(fomites, lesions)
Droplet Isolation
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Varicella
(Chickenpox)
Herpes Simplex
Mucocutaneous,
disseminated or primary
severe
Human
Immunodeficiency
Virus (HIV)/AIDS
Immunosuppressive
Treatment
Neutropenia
Impetigo
Influenza
(and Parainfluenzae)
Legionellosis
Legionaires Disease
Leptospirosis
Until 2 negative cultures
taken 24 hours apart are
obtained and after
cessation of antimicrobial
therapy
Duration of illness or until
clear culture for HCW &
Food Handlers
Until substantial healing
occurs
Duration of illness
Until 48 hours symptom
free or clear culture for
HCW & Food Handlers
Contact
Duration of illness
Standard Precautions
Standard Precautions
Standard Precautions
Duration of illness
Duration of illness
Contact Isolation
Airborne
Duration of illness
For duration of infectivity,
until all lesions are dry and
crusted over
Contact
For duration of infectivity,
until all lesions are dry and
crusted over
NA
Standard Precautions
Until substantial clinical
improvement
NA
Protective
When Neutrophils are
≥ 0.5 x10^9/l
Direct & indirect contact
Contact Isolation
Droplet
Droplet
Inhalation of aerolised
contaminated
water/potting mix (not
person to person)
From animal urine contact
with open wounds/
mucous membranes
Standard Precautions
Until 24 hours after
initiation of effective
antibiotic treatment
7 days from onset of
illness or until 24 hours
symptom free
Standard Precautions
Human to human
transmission is rare
Standard Precaution and Transmission-based Precaution Procedure
Page 11 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
Lice
(pediculosis)
Contact direct & indirect
Contact Isolation
Lymphoma, leukaemia
NA
Protective
Measles
Droplet, direct / indirect
contact with respiratory
secretions
IP: 10 days
Infectivity: Prodromal
until day 4 of rash
Droplet
Airborne
MRSA (confirmed)
Direct / indirect contact,
respiratory
Contact
MRSA (Suspected)
Direct, indirect contact
Contact
Mumps
Droplet/contact,
respiratory secretions
Droplet
Norovirus
Indirect contact
Droplet
Onset acute
Direct / indirect contact
with wound or exudates
Droplet
Droplet/contact
Plague
(pneumonic)
Droplet
Droplet
Polio
Puerperal Sepsis
Ingestion
Direct / indirect contact
with vaginal secretions
Aerosol Droplet
Contact
Contact/droplet
Respiratory Syncitial
Virus (RSV)
Rhinovirus
Rotavirus
Contact/droplet
Droplet
Contact/droplet
Faecal-oral, respiratory
Droplet
Contact/droplet
Rubella
Contact/droplet
Droplet
Salmonella typhi
Faecal-oral
IP: 12-48 hours
Contact
Meningococcal
Meningitis
Other Wound Infections
Pertussis (Whooping
Cough)
Pulmonary
Tuberculosis
Droplet
Contact
Droplet
Airborne / N95 mask
Until 24 hours after
initiation of effective
treatment
Until substantial clinical
improvement
Until 4 days after onset of
rash
Non immune staff should
not care for patient
Until 24 hours after start
of effective antibiotic
treatment
Until 3 negative cultures
have been obtained 24
hours apart. This will
occur 48 hrs after 7 day
treatment completed
Until negative culture
established
For 9 days after onset of
swelling. Exposed nunimmune people should be
considered infectious
from 12th-25th day after
exposure, with or without
symptoms
Infectivity duration of
illness, until 48 hours
symptom free
Until negative culture
obtained
7 days after
commencement of
antibiotics. If no
antibiotic treatment isolate
for 3 weeks after onset of
paroxysm cough
All patients for 24 hours
after beginning antibiotic
treatment
Duration of illness
Duration of illness
2 weeks after
commencement of
effective drug therapy. (3
negative sputum cultures)
Duration of illness
Duration of illness
Until 48 hours symptom
free
Until 7 days after onset of
rash
Until 48 hours symptom
free or clear culture
obtained HCW & Food
Handlers
Standard Precaution and Transmission-based Precaution Procedure
Page 12 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
Sars
Droplet
Airborne contact
Airborne/Contact
N95 mask
Scabies, Body lice,
Head lice
Septic Arthritis
Direct skin contact
Contact
Duration of illness + 10
days after resolution of
fever, provided respiratory
symptoms are absent or
improving
Duration of illness
Direct and indirect contact
with open wound
Faecal-oral
IP: 2-4 days
Contact
Duration of illness
Contact
Shingles
Staphylococcal Wound
Infection
Streptococcal Wound
Infection
Direct contact
Direct / indirect contact
with wound and exudates
Direct / indirect contact
with wound and exudates
Contact
Contact
Vibrio cholerae
Direct / indirect contact
Faecal-oral
route/ingestion
Faecal-oral route
Contact
Contact
Contact
Until 48 hours symptom
free or clear culture
obtained HCW & Food
Handlers
Until symptoms subside
Until negative culture
obtained
Until 24 hours after
antibiotic treatment
commenced
Duration of illness or until
clear culture obtained for
HCW & Food Handlers
Until 48 hours symptom
or clear culture obtained
HCW & Food Handlers
Duration of illness
Shigella
Yersinia
Vancomycin-resistant
Enterococcus (VRE)
Contact/droplet
Contact
3.00 General Guidelines for Isolation, but PPE utilized according to mode of
Transmission of Infectious agent.
Criteria
Room
Protective Clothing
- Gown
- Mask
- Gloves
Handwashing
Rubbish (including dressings)
Linen
Sharps
Laboratory Specimens
Visitor Requirements
Transportation of Patient
Body Fluids
Articles
Application
Single with door closed. Air filtering systems are adopted where possible
Long sleeved, worn by all persons entering room } Governed by type of Isolation
Filter mask, worn by all persons entering room }
Disposable, worn by person having direct contact with the patient
Before entering the room and after leaving the room, and as per 5 Moments
hand hygiene.
Collected at point of exit from room. Contaminated rubbish is double bagged
in yellow rubbish bag
Collected at point exit from the room. Change daily.
Point of use sharps disposal into designated sharps container
Ensure lid is closed tight. Transport in biohazard bag.
Restricted visiting as patient indicates.
Handwashing prior to entering and on exiting the room.
In palliative situations the needs of the patient to have family and friends
accessible, should be observed and accommodated.
Only if absolutely necessary. Patient wears filter mask and isolation gown.
Wounds are covered – Depending on type of isolation.
Treat all blood and body fluids as being potentially contaminated
Cleaned and disinfected.
Standard Precaution and Transmission-based Precaution Procedure
Page 13 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
When a patient is in isolation, it is important that information in clearly communicated to
all relevant staff including:
4.00
Visitors to Isolation Rooms
4.01
Family/whanau/friends should be encouraged to visit the patient restricted to isolation
as this assists the person to maintain their social integration especially if they are in
isolation for some considerable time.
4.02
Visitor numbers however should be restricted at any one time to prevent overcrowding.
4.03
Visitors should be encouraged to visit other hospitalised patients first before entering
the isolation room, and not visit other hospital areas after visiting the isolation patient.
4.04
Visitors need to have correctly demonstrated to them by ward staff the correct
protective clothing to wear while visiting a patient in isolation and its disposal at the end
of the visit.
4.05
Visitors are to be discouraged from frequently leaving and entering the room while
visiting.
4.06
Visitors are to wash their hands when leaving the isolation room.
5.00
Staff Entering Isolation Rooms (Including Orderly staff)
5.01
Medical Nursing and allied health staff are required to abide by the following when
entering an isolation room:
i)
White coats and stethoscopes should be left outside the room.
ii)
Long sleeved shirts etc should be rolled up.
iii)
Personal protective equipment should be worn depending on the type of
isolation.
iv)
Any personal equipment is wiped with an alcohol wipe. Personal protective
equipment (PPE) is removed and hand hygiene is performed prior to exiting
room.
5.02
Laboratory staff are required to abide by the following when entering an isolation room:
i)
Check with ward staff re isolation requirements. Roll up sleeves to elbows.
ii)
Take only required equipment into room leaving the collection box outside.
iii)
Clean hands as per the 5 moments obtain specimen, place paper waste into
rubbish bag, including disposable tourniquet, dispose of sharps into the
appropriate container.
iv)
Remove PPE performs hand hygiene
iv)
Place specimen into biohazard bag held outside the room by an assistant.
vi)
Wash hands and leave the room.
6.00
Transporting Patients Who Are In Isolation
6.01
Staff members involved in receipt of or transfer of patient are to be informed in
advance of any such movements, so the appropriate precautions can be put in place.
Standard Precaution and Transmission-based Precaution Procedure
Page 14 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
6.02
Instruct patient to perform hand hygiene prior to leaving his/her room if able too. If
they are unable to do so nursing staff are to assist the patient to ensure hand hygiene is
performed.
6.03
All wounds must be covered with a clean dressing, all drainage bags should be emptied
prior to transferring the patient, unless a closed system is in place.
6.04
If transported by wheelchair they must be seated on a clean sheet and covered with
another clean sheet. If patient is to be transported by bed, linen must be clean and
covered with a clean sheet. Patient is to wear a surgical mask if they are in droplet or
protective isolation; if they are in airborne isolation they must wear a N95 high filtration
mask. Staffs accompanying these patients with either droplet or airborne isolation are
to wear the appropriate mask also.
7.00
Cleaning Of Isolation Rooms
7.01
It is a nursing responsibility to provide a clean comfortable environment that is
conclusive to rest and rehabilitation, this includes ensuring adequate rubbish and linen
disposal.
7.02
Cleaning staff are responsible for cleaning the isolation room daily. This is to include:
i)
Floors mopped daily with detergent and warm water using a Microfiber mop
and plastic wringer bucket.
ii)
Bucket is cleaned daily with Ajax (or similar), rinsed and dried well, stored
upside down.
iii)
Mops are sent to the laundry every 12 hours, contained in a plastic bag.
If the patient is discharged from the isolation unit, the mop is once again sealed
in a clear plastic bag and sent to the Laundry or disposable mops are used.
v)
Wash basins are cleaned with hypochlorite cleaner and disposable cloth (
vi)
Personal Protective Equipment is to be worn by all cleaning staff whilst in the
isolation room as stipulated by the Isolation protocol.
vii)
Toilets and bathrooms of isolation rooms are cleaned with Ajax (or similar).
viii)
A designated disinfectant is used in heavily contaminated areas.
7.03
Terminal cleaning is the final cleaning of the unit, when the patient is discharged from
the isolation unit.
7.04
Terminal cleaning is carried out by the orderlies, who are contacted when a room is
vacated. It is the wards responsibility to provide the necessary information, protective
clothing, equipment and solution to ensure the job is carried out safely, effectively and
efficiently.
7.05
Terminal cleaning involves cleaning the following:
i)
Floors
ii)
Walls
iii)
Beds
iv)
Lockers
v)
Curtains
vi)
Hand basins
vii)
Door handles
viii)
Window handles
Standard Precaution and Transmission-based Precaution Procedure
Page 15 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
ix)
x)
Nurses call bell
Light switches
The following cleaning is required depending on the type of precautions that were used:
Droplet and Airborne
Walls.
Basin.
Floor.
Bed and mattress.
Curtains.
Locker.
Commonly touched
items.
All horizontal surfaces
Contact
Basin.
Floor.
Bed and mattress.
Locker.
Commonly touched items.
All horizontal surfaces
Curtains.
Protective
No special precautions required.
7.07
Types of cleaning solutions depend on contaminants and extent of cleaning depends on
type of isolation:
• Oxivir solution is used for environmental cleaning for bacterial infections. .e.g.
MRSA
• Precept 1:10 solution is used for environmental cleaning for viral infections. E.g.
Norovirus/Rotavirus
• Oxivir solution, is for environmental cleaning for bacterial spores and emerging
novel viruses, and as directed by Infection Control Committee. E.g. C. Difficile
7.08
Linen, rubbish, utensils, fomites (inanimate object that can transmit infectious
organisms e.g. soap & clothing) should all be cleared and packed by nursing staff prior
to the orderly doing the terminal clean.
8.00
Packaging Contaminated Items From Isolation Room - are placed into clear plastic
bags and transported to CSSD by orderlies.
8.01
Plastic meal trays and crockery are collected last and placed into clear plastic bags and
sent to the Kitchen Dishwashing Department where they are processed last
8.02
Toys are to be washed and disinfected, if unsuitable for cleaning they are to be
discarded.
8.05
8.07
Blood pressure cuffs, stethoscopes, light shades, tourniquets etc. are to be wiped over
with appropriate solution; unless heavy contamination is obvious then they should be
discarded.
Linen should be transported to the laundry, double bagged with the second bag being
Impervious with yellow strip.
Curtains should be double bagged into clear plastic bag and clearly labelled.
9.00
Fibre Cleaning – Grey Hospital
9.01
When cleaning an Isolation Unit, staff must wear protective clothing, i.e. gowns, gloves
etc, depending on type of isolation – refer to Unit Manager.
8.06
Standard Precaution and Transmission-based Precaution Procedure
Page 16 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
7.
9.02
Use a GP Micro Cloth for dusting.
9.03
Hand basins are to be washed with a GP Micro Cloth.
9.04
Toilets, showers and baths are also to be cleaned with a GP Micro Cloth.
9.05
A designated disinfectant is used in heavy contaminated areas.
9.06
Mop Heads and GP Micro Cloths are to be placed in with the dirty cloths and mops in
a clear plastic bag.
9.07
The handle of mops are to be wiped down with a clean GP Micro Cloth.
Precautions and Considerations
 Hands and other skin surfaces must be washed immediately with soap and water if they have
become contaminated
 Staff members with exudative lesions or weeping dermatitis are to refrain from all direct
patient contact
 Personal Protective Equipment is to be worn if there is potential for contact with blood or
body fluids
 N95 masks (P2 ) respirators must be worn by all staff entering Airborne Isolation rooms
 Handwashing is the single most effective practice for preventing the spread of infections
 Visitors need to have correctly demonstrated to them by ward staff the correct protective
clothing to wear while visiting a patient in isolation and its disposal at the end of the visit
 Staff members involved in receipt of or transfer of a patient are to be informed in advance of
any such movements, so the appropriate precautions can be put in place
 This Policy & Procedure is used in conjunction with the Isolation Flip Chart
8.
References
New Zealand Standard – Infection Control (NZS 8142:2008).
Australian Guideline for the Prevention and Control of Infection in Healthcare. Australian
Government (2010) p20-22.
Guideline for Isolation Precautions:
Prevention the Transmission of Infectious Agents in
Healthcare settings (CDC 2007).
Practical Guidelines for Infection Control in Healthcare Facilities; World Health Organisation,
(2004).
SDHB Infection Control Policy & Procedure, Transfer of Isolation Patients Ref 2894634.
Standard Precaution and Transmission-based Precaution Procedure
Page 17 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD
9.
Related Documents
WCDHB Infection Control Procedure Manual
WCDHB Health & Safety Policy and Procedure Manual
Guidelines for Tuberculosis Control in New Zealand (2010)
Practical Guidelines for Infection Control in Healthcare Facilities (WHO, 2004)
Revision
History
Version:
Developed By:
Authorised By:
Date Authorised:
Date last Reviewed:
Date of next Review:
8
CNS- Infection Prevention & Control
Infection Control Committee
August 2008
March 2015
February 2017
Standard Precaution and Transmission-based Precaution Procedure
Page 18 of 18
(Includes Isolation Requirements)
Document Owner: Infection Control Committee
WCDHB-IC66, Version 8, Revised March 2015
Master Copy is Electronic
UNCONTROLLED DOCUMENT – WEST COAST DISTRICT HEALTH BOARD