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INFECTION
PREVENTION
&
CONTROL
MANUAL
Updated: November 2016
Infection Prevention and Control
Disclaimer
Disclaimer
The Interior Health Infection Prevention & Control Manual (the Manual) is intended as a reference document
only. The Manual represents Interior Health’s guidelines and does not imply directly or indirectly that non
Interior Health programs or facilities are bound by the guidelines. While non IH users are encouraged to
develop their own infection prevention and control guidelines, these individual groups may choose to adopt
the guidelines in the Manual as their iown provided all references to Interior Health are removed.
The most up-to-date version of the Manual is the electronic copy on the website. If a paper copy is being
maintained it is the responsibility of the users to ensure they have the most current best practise information
to guide their treatments and interventions.
The Manual (paper or electronic version) and all the information it contains is provided “as is” without
warranty of any kind, whether expressed or implied. All implied warranties, including, without limitation,
implied warranties of merchantability, fitness for a particular purpose, and non-infringement, are hereby
expressly disclaimed.
Limitation of Liabilities
Under no circumstances will the Interior Health Authority be liable to any person or business entity for any
direct, indirect, special, incidental, consequential, or other damages based on any use of the Manual,
including, without limitation, any lost profits, business interruption, or loss of programs or information, even if
the Interior Health Authority has been specifically advised of the possibility of such damages.
Infection Prevention and Control
Summary of Changes to Infection Prevention and Control Manual
Summary of Changes to Infection Prevention & Control
Manual
November
2016
 The Revised IH Infection Prevention & Control Manual is available on the InsideNet at Clinical
Resources or Policies & Procedures or Quality & Patient Safety and on the Internet at
http://www.interiorhealth.ca/AboutUs/QualityCare/Pages/InfectionControl.aspx
 All staff are expected to use the “on line” copy of the manual which contains the most up to date
information.
 There is one “hard copy” of the manual available at each Acute and Residential site in the event that the
electronic copy cannot be accessed.
 Please refer to the table below for: “New” and “Revised” guidelines that have been added to the manual.
The paper version of this manual requires updating with this information.
Section(S) Revised
R= Revised
N = New
Throughout the manual:


The term “patient” is inclusive of patient, resident & client.
There are links to signage and other tools on the InsideNet – Infection Prevention & Control Home page.
Section 03F – Routine Practices
Revisions include:
IF0100 Routine Practices
for All Care Areas
R
Donning and Doffing of PPE (personal protective equipment) photo instructions
updated
IF0200 Hand Hygiene
R
3.6 When Clostridium difficile infection is suspected or diagnosed:
 Wash hands with soap and water (preferred).
 If no sink is in close proximity, clean hands with alcohol hand rub and
wash with soap and water at first opportunity.
 Do not perform hand hygiene at a patient sink, as this may cause
recontamination of the health care provider’s hands. Use a dedicated staff
hand washing sink
Section 04H – Additional Precautions
Revisions Include:
IH0200 Airborne
Precautions
R
Updated signs including Point of Care Risk Assessment, Airborne Precautions
and Airborne & Contact Precautions
IH0300 Droplet
Precautions
R
Updated signs including Point of Care Risk Assessment, Droplet Precautions and
Droplet & Contact Precautions
IH0400 Contact
Precautions
R
Updated signs including Point of Care Risk Assessment, Contact Precautions and
Contact Plus Precautions
Section 08S – Specific Diseases
Revisions Include:
IS0200 Clostridium
difficile
R
3.2 Hand Hygiene
 Wash hands with soap and water (preferred)
 If no sink is in close proximity clean hands with alcohol-based hand rub
(ABHR) and wash with soap and water at first opportunity
 Do not perform hand hygiene at a patient sink, as this may cause
contamination of the healthcare provider’s. Use a dedicated staff hand
washing sink
Infection Prevention and Control
Table of Contents to Infection Prevention and Control Manual

Assist patients with cleaning their hands, especially after toileting and
before meals
3.3 Patient Placement and Accommodation
 Brown Contact Precautions signage placed at entrance to the patient
room, cubicle or designated bed space (i.e.) Emergency Department
3.7 Cleaning of Patient Environment
 The brown Contact Precautions sign alerts Housekeeping staff of the
need for twice daily cleaning with a sporicidal disinfectant
Updated sign Contact Plus Precautions
Infection Prevention and Control
Table of Contents to Infection Prevention and Control Manual
TABLE OF CONTENTS
MANUAL INTRODUCTION
IB0100: Interior Health Infection Prevention & Control Program
ROUTINE PRACTICES
IF0100: Routine Practices for All Care Areas
IF0200: Hand Hygiene Guidelines
IF0300: Waste Management
ADDITIONAL PRECAUTIONS
IH0100: Additional Precautions For
All Care Areas
IH0200: Airborne Precautions
IH0300: Droplet Precautions
IH0400: Contact Precautions
SPECIFIC DISEASES
IS0100: Reportable Communicable Diseases
IS0200: Clostridium difficile
IS0300: Antibiotic Resistant Organisms (ARO)
IS0300A: Carbapenemase Producing Organisms (CPOs)
IS0400: Scabies/Lice
IS0500A: Tuberculosis
IS0500B Tuberculosis Risk Screening – Residential Facilities
IS0600: Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)
IS0700: Invasive Group A Streptococcal Infections (IGAS)
IS0800: Meningococcal Infection
IS0900: Creutzfeldt-Jakob Disease
IS1000: Respiratory Syncytial Virus (RSV)
IS1100: Rabies
IS1200
Measles
IS1300
Mumps
IS1400
Bed Bugs
IS1500
Pertussis
SURVEILLANCE AND OUTBREAKS
IV0100: Surveillance for Healthcare Associated Infections
IV0200: Definitions for Healthcare Associated Infections
IV0300: Surgical Site Infections (SSIs)
IV0400: Gastrointestinal Outbreak Guidelines
IV0500: Respiratory Infection (RI) Outbreak Guidelines
IV0600: Communicable Diseases in Employees
BEST PRACTICES
IX0100: Microbiology Specimen Collection
IX0200: Prevention & Control of Catheter Associated Urinary Tract Infections (CAUTI)
IX0300: Pneumococcal Vaccine for Residential Care
IX0400: Pet Therapy and Visitation
IX0500: Soiled Utility Rooms
IX0600: Equipment Cleaning
IX0700: Toy Management
IX0800: Personal Care Supplies Best Practice Guidelines
IX0900: Construction Projects
IX1000: Construction & Renovation Guidelines
Infection Prevention and Control
Cross Reference to Infection Prevention and Control Manual
CROSS REFERENCE
A
Acute Care Plan for (ARO’s)
Acute Care Plan for Clostridium difficile
Additional Precautions for all Care Areas
Table 6: Transmission
Characteristics and Empiric
Precautions by Clinical
Presentation: Recommendations
for Acute Care Centres
IS0300
IS0200
IH0100
Acute Care Admission Screening Form #807910
IH0200


Table 7: Transmission
Characteristics and Precautions by
Specific Etiology:
Recommendations for Acute Care
Centres
Airborne Precautions

Antibiotic Resistant Organisms for Acute
Care
IS0300
Antibiotic Resistant Organisms for
Residential Care
 Residential Care Plan
Antimicrobial Resistant Organisms (ARO)
Precautions for Community Care
Antimicrobial Resistant Organisms (ARO)
Antimicrobial Resistant Organisms (ARO)
Residential Care
IS0300
Airborne Precautions Sign #807900
Airborne / Contact Precautions Sign
#807901
Airborne Communicable Disease Algorithm
#807907
IS0300
IS0300
IS0300
B
C
CCARO (Community Care Antibiotic
Organisms)
Carbapenemase Producing Organisms
Care Plan – Resident with CDI
Care Plan – Acute Care with CDI
Care Plan – Acute for AROs
Care Plan – Residential for AROs
Care Plan – Community for AROs
IS0300
Chickenpox and Herpes Zoster (Shingles)
Catheter Associated Urinary Tract
Infections (CAUTI)
Clostridium difficile
IS0600
IX0200
IS0300A
IS0200
IS0200
IS0300
IS0300
IS0300
IS0200
Clostridium difficile Contact Precautions Sign
#807914
Infection Prevention and Control
Cross Reference to Infection Prevention and Control Manual
Clostridium difficile – Resident with CDI
Collection of Specimens in a
Gastroenteritis Outbreak
Common Agents and Illness –
Gastroenteritis (GI) Illness
Community Care Plan for AROs
Communicable Diseases in Employees
Construction Projects
IS0200
IV0400
IV0400
IS0300
IV0600
IX0900
Construction & Renovation Guidelines
Contact Precautions
IX1000
IH0400
Creutzfeldt-Jakob Disease
IS0900
Contact Precautions Sign #807902
D
Definitions of Health Care Associated
Infections
Droplet Precautions for Acute Care
IV0200
IH0300
E
Equipment Cleaning
Exposure – Blood and Body Fluid
(see IH Policy AV0300)
G
Gastroenteritis Illness Outbreak guidelines
IV0400
H
Hand Hygiene Guidelines
Herpes Zoster
IF0200
IS0600
HIV Exposure (see IH Policy AV0300)
I
Interior Health Infection Prevention &
Control Program
Influenza Immunization Policy for
Employees
(See IH Policy AV1300)
Influenza Like Illness Outbreak
IB0100
Invasive Group A Streptococcal Infections
(IGAS)
IS0700
IV0500
L
Lice/Scabies
IS0400


Droplet Precautions Sign #807903
Droplet / Contact Precautions #807904
Infection Prevention and Control
Cross Reference to Infection Prevention and Control Manual
M
Meningococcal Infection
IS0800
Microbiology Specimen Collection
IX0100
N
Needlestick Exposure
(see IH Policy AV0300)
O
Outbreak Facility Sign
IV0400

Form #807909
P
Personal Care Supplies Best Practice
Guideline
Pet Therapy and Visitation
Pneumococcal Vaccine for Residential
Care
Prevention & Control of Catheter
Associated Urinary Tract Infections
(CAUTI)
IX0800
IX0400
IX0300
IX0200
Q
Quick Reference Guide – Respiratory
Illness Outbreak
Quick Reference Guide for GI Outbreaks
IV0500
IV0400
R
Rabies
IS1100
Reference guide – Respiratory Illness
Outbreak
Reference Guide for GI Outbreaks
IV0500
Renovation Guidelines, Construction and
Reportable Communicable Diseases
IX0900
IS0100
Residential Care Plan ARO
Residential Care Plan Clostridium difficile
IS0300
IS0200
IV0500
IS1000
IF0100
IS0300
Respiratory Infection (RI) Outbreak
Respiratory Syncitial Virus (RSV)
Routine Practices for all Care Areas
Routine Screening for Antibiotic Resistant
Organisms (AROs) form
IV0400
Schedule A - List of Reportable Communicable
Diseases in BC
Infection Prevention and Control
Cross Reference to Infection Prevention and Control Manual
S
Scabies/Lice
IS0400
Schedule A (Reportable Communicable
Diseases)
Shingles
Soiled Utility Rooms
IS0100
Specimen, Collection of Gastroenteritis
Outbreak
Specimen, Transport of
IV0400
Surgical Site Infections
Surveillance of Health Care Associated
Infections
IV0300
IV0100
IS0600
IX0500
IV0400
T
Toy Management
Transmission Characteristics and Empiric
Precautions by Clinical Presentation:
Recommendations for acute Care
Centres (Table 6)
Transmission Characteristics and
Precautions by Specific Etiology:
Recommendations for Acute Care
Centres (Table 7)
Transportation of Patients on Isolation or
Additional Precautions
Tuberculosis
IX0700
IH0100
IH0100
IH0100
IS0500A
IS0500B
U
Urinary Tract Infections (Prevention of)
IX0200
W
Waste Management
IF0300
Infection Prevention and Control
Introduction to Infection Prevention and Control Manual
MANUAL INTRODUCTION
1.0
PURPOSE
The Manual has been prepared to assist healthcare providers in implementing infection prevention
and control best practice strategies across the continuum of care. The principles and guidelines set
out in the Manual are based on published best practices, national and international, which have been
modified to reflect the specific needs of Interior Health (IH). The Manual will be updated as best
practices evolve, and the most current edition will be posted on the INFECTION PREVENTION &
CONTROL WEBSITE.
This document covers acute, residential, and community care settings and programs. Note: In this
document the term “patient” is inclusive of patient, resident & client. The implementation of
routine infection control principles applies to all healthcare providers and patients in all healthcare
settings all the time.
The goal of infection control practices is to reduce the risk of transmission of infectious
microorganisms in all healthcare settings by:
 Understanding the concepts of the chain of transmission;
 Understanding the concepts and application of Routine Practices (RP);
 Knowing why and when to use Additional Precautions (AP); and
 Appropriately using, applying and removing personal protective equipment (PPE) when indicated
for the protection of the patient or the healthcare provider.
2.0
DEFINITIONS
Aseptic Technique – refers to practices designed to render the patient’s skin, supplies and surfaces
maximally free from microorganisms. Such practices are required when performing procedures that
expose the patient’s normally sterile sites e.g., intravascular system, spinal canal, subdural space,
and urinary tract, in such a manner to keep them free of microorganisms.
Community- Acquired Infections – infections present or incubating at the time of admission to a
healthcare facility or program with no association to a recent hospitalization.
Health Care Associated Infection (HAI) – an infection that is not present or incubating at the time of
admission to a healthcare facility or program but is associated with admission to or a procedure
performed in a the facility or program.
Infection – occurs when microorganisms invade a body site, multiply in tissue and cause clinical
manifestations of local or systemic inflammation (e.g. fever, redness, heat, swelling, pain, etc.)
PPE – personal protective equipment are barriers used by healthcare providers to protect mucous
membranes, airways, skin and clothing from exposure to blood and body fluids.
Infection Prevention and Control
Introduction to Infection Prevention and Control Manual
3.0
GUIDING PRINCIPLES
FIGURE 1 - The Chain of Infection – How Microorganisms are Spread
Disclaimer for Figure 1 and
2
This was developed by
the Provincial Infectious
Diseases Advisory
Committee (PIDAC).
PIDAC is a
multidisciplinary
scientific advisory body
who provide to the Chief
Medical Officer of Health
evidence-based advice
regarding multiple
aspects of infectious
disease identification,
prevention and control.
PIDAC’s work is guided
by the best available
evidence and updated
as required. Best
Practice documents and
tools produced by
PIDAC reflect
consensus positions on
what the committee
deems prudent practice
and are made available
as a resource to the
public health and health
care providers.
Infection Prevention and Control
Introduction to Infection Prevention and Control Manual
FIGURE 2 - An infection can be prevented by breaking any link in the chain of infection. Infection
control measures are designed to break the links and thereby prevent an infection from occurring.
Here are the six links in the chain of infection and how these links can be broken so an
infection does not occur:
1. Causative (infectious) agent including bacteria, viruses, fungi, prions and parasites
 Break the link by eliminating or inactivating the agent, preventing the agent from exiting the
reservoir, sterilizing surgical instruments, safe food practices, safe drinking water,
vaccinations, treating infectious individuals, practicing good hand hygiene.
2. Reservoir or “home” of the infectious agent including the human body, animals and the
environment (water, food)
 Break the link by treating infectious individuals, vaccination, handling and disposing of body
fluids appropriately, safe food practices, monitoring water for contamination.
3. Portal of exit is the path by which an infectious agent leaves the reservoir or “home” including
any break in the skin or any bodily fluid such as secretions, excretions and blood.
 Break the link by implementing safe practices such as covering coughs and sneezes,
handling body fluids with gloves, performing appropriate hand hygiene, and containing
draining wounds. Healthcare providers should not work if they have exudative (wet) lesions
or weeping dermatitis.
4. Mode of transmission – how the infectious agent travels from one place to another; the
mechanism for transfer of an infectious agent from a reservoir to a susceptible host. “Vectorborne” diseases are spread by insects, rodents, birds and animals. Common vehicle
transmission refers to a single contaminated source such as food, multi-dose vials, intravenous
fluid or equipment which serves to transmit infection to multiple hosts. The primary modes of
transmission in healthcare include:
 Contact – direct contact which is person to person spread or indirect contact which is
contact with a contaminated surface or inanimate object to person spread.
 Droplet – where large particles are produced when an infected person sneezes, talks or
coughs and settle out on horizontal surfaces leading to indirect contact transmission or direct
contact onto another person’s mucous membranes; droplets can travel 1 - 2 metres.
 Airborne – where organisms are contained within droplet nuclei (five microns or smaller in
size) or dust particles in the air and the infectious agent is widely dispersed by air currents
and inhaled by a susceptible host (e.g. Tuberculosis).
 Break the link by ensuring transmission between objects or people does not occur;
use appropriate barriers, safe practices, spatial separation, engineering controls,
hand hygiene, environmental sanitation, and equipment disinfection/sterilization.
5. Portal of entry into a susceptible host via mucous membrane, GI, respiratory or broken skin. All
portals of entry have natural protective barriers. These barriers are normally effective but may
allow micro organisms to enter if the barriers are damaged or if they have been compromised by
invasive medical devices (e.g. catheters).
 Break the link by performing appropriate hand hygiene, using aseptic technique when
required, applying best practice techniques with wound and catheter care, wearing
appropriate PPE, eliminating invasive devices when safe to do so and providing safe food
and water.
6. Susceptible Host occurs when the normal balance between microorganisms and their host may
be disturbed by chronic diseases that cause an altered immune status e.g. diabetes , infancy, old
age, invasive procedures, drug therapy, poor nutrition, radiation, chemotherapy, burns, etc
 Break the link by ensuring hosts are not susceptible including measures such as
immunizations, good nutrition, recognition and treatment of high risk patients
Infection Prevention and Control
Introduction to Infection Prevention and Control Manual
BY UNDERSTANDING THE CHAIN OF INFECTION, THE PROCEDURES DESCRIBED IN THIS MANUAL CAN BE
APPLIED TO INTERRUPT MICROBIAL TRANSMISSION BETWEEN PATIENTS/RESIDENTS, VISITORS, AND
HEALTHCARE PROVIDERS.
2.0
REFERENCE
2.1
Routine Practices and Additional Precautions In all Healthcare Settings. Provincial Infectious
Diseases Advisory Committee (PIDAC), Ontario; November 2012.
2.2
Routine Practices and Additional Precautions for Preventing the Transmission of Infection in
Health Care Settings; Public Health Agency of Canada; 2013.
2.3
Infection Prevention and Control Manual. Vancouver Island Health Authority (VIHA);
2009.
2.4
APIC Text 2012.
Infection Prevention and Control
Interior Health Infection Prevention and Control Program
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IB0100:
Interior Health Infection Prevention
& Control Program
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
REVIEWED DATE: February 2015
1.0
PURPOSE
To protect patients, staff and visitors from infectious organisms within the healthcare environment the
Interior Health Infection Prevention & Control (IPAC) Program has three principle goals:
 Protect the patient.
 Protect the healthcare provider, visitors and others in the healthcare environment.
 Accomplish the previous two goals in a cost-effective manner whenever possible.
2.0
DEFINITIONS
Healthcare Associated Infections (HAIs) – infections that are not present or incubating at the time
of admission to the facility or program but are associated with admission to or a procedure performed
in a healthcare facility or program.
3.0
GUIDING PRINCIPLES
3.1
The IPAC Program functions in accordance with international, national and provincial
guidelines and best practices across the continuum of care.
3.2
The IPAC Program influences practice through direct actions including the following:
 Manages critical data including surveillance for infections and disseminates data to
appropriate stakeholders.
 Develops and recommends policies, procedures and best practices in IPAC including
but not limited to Routine Practices, Additional Precautions, asepsis, equipment
cleaning, disinfection and sterilization, product selection and evaluation, and
construction consultation as it pertains to IPAC.
 Intervenes directly to prevent infections and includes liaison and consultation with
community agencies and programs.
 Educates and trains healthcare providers, patients and nonmedical caregivers.
3.3
A multidisciplinary IPAC Committee with representation from across the continuum of care
including administration, clinical and ancillary staff acts as an advocate for the prevention and
control of HAIs, to promote patient safety and provide support that empowers the
implementation of best practices both at the local and corporate level of the organization.
3.4
Each multidisciplinary committee requires its own Terms of Reference that identifies its
purpose, responsibilities, membership and reporting expectations to ensure appropriate
dissemination of information and facilitates medical and administrative support for the IPAC
Program.
.
Infection Prevention and Control
Interior Health Infection Prevention and Control Program
Page 2
3.5
The IPAC Program provides an Annual Report which clearly identifies the goals and priority
objectives of the program and the key improvements for monitoring infection prevention &
control practices that have influenced practices aimed at improving safety for patients and
staff and allocating IPAC resources appropriately.
.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IF0100: Routine Practices for All
Care Areas
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
December 2012, November 2016
REVIEWED DATE:
1.0
PURPOSE
Routine Practices are infection prevention and control practices designed to reduce the risk of blood
and body fluid exposures to healthcare workers AND to prevent and control contamination and
transmission of microorganisms in all healthcare settings.
2.0
DEFINITIONS
3.0
See the glossary in Appendix A for definitions.
.
GUIDING PRINCIPLES
Routine Practices
Routine Practices are used by ALL healthcare providers
for ALL patients/residents/clients
in ALL settings
ALL of the time
3.1
Routine Practices must be incorporated into the culture of each healthcare setting and into
the daily practice of each healthcare provider.
3.2
Routine Practices apply to all BODY FLUIDS, NON-INTACT SKIN, MUCOUS MEMBRANES OR
EQUIPMENT CONTAMINATED WITH BLOOD, BODY FLUIDS OR TISSUES.
3.3
A Point of Care Risk Assessment must be done by healthcare providers before each
interaction with the patient or their environment to determine which interventions are
required to prevent transmission of microorganisms during that interaction.
 Choose patient placement or accommodation based on the risk assessment.
 Choose personal protective equipment (PPE) based on the risk assessment.
3.4
PPE is used to prevent transmission of infectious agents both from patient-to-patient and
from patient-to-healthcare provider. Healthcare settings must ensure sufficient supplies of,
and quick, easy access to PPE is provided.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 2
3.5
Preventing transmission of microorganisms to other patients is a patient safety issue, and
preventing transmission to staff is an occupational health and safety issue. Healthcare
providers are accountable to practice safely to protect patients and themselves by following
organizational infection prevention and control guidelines.
Just because it ‘looks’ clean doesn’t mean it isn’t contaminated by bacteria or viruses
4.0
PROCEDURE
4.1
Point of Care Risk Assessment - to be done before each interaction with a patient or
their environment.
Assess the patient for high risk of contaminating environment:
 Uncontrolled diarrhea.
 Uncontained draining wounds or skin lesions.
 Uncontrolled respiratory symptoms.
 Symptoms – vomiting, fever, skin rash.
 Inability to clean hands or cover cough.
What type of environment is high risk for patient?
 Shared space (i.e.) multi-bed room, shared bathrooms.
 Crowded areas such as waiting rooms, hallways.
 Shared equipment.
4.2
Use avoidance procedures that minimize contact with droplets (e.g., sitting next to, rather
than in front of, a coughing patient when taking a history or conducting an examination).
4.3
Hand Hygiene Refer to IF0200 HAND HYGIENE GUIDELINE
Activity
Best Practice
Hand Hygiene
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Before and after every patient/patient environment contact.
After contact with blood or body fluids, soiled linen, equipment or garbage.
Before and after glove use.
Before performing aseptic procedures.
Before handling food or medication.
Before handling clean linen or supplies.
After using the toilet or after toileting others.
After changing an incontinence product or a child’s diaper.
Prior to using computers and other electronic devices.
Alcohol-based hand rub (ABHR) used routinely when hands are not visibly
soiled.
Soap and water used when hands are visibly soiled.
Assist patients with hand hygiene before eating, after toileting and when
hands are soiled.
Educate visitors about hand hygiene.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 3
4.4
Personal Protective Equipment (PPE)
Determine the appropriate PPE to use that will decrease exposure risk and prevent
transmission of infectious agents: includes gloves, masks, N95 respirators, eye protection,
and gowns/aprons.
Activity
Best Practice
Gloves – non
sterile, single
use, latex free
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Masks and eye
protection
▪
▪
▪
▪
▪
N95 Respirators
Gowns/aprons –
single use
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Wear for contact with blood or body fluids, mucous membranes, draining
wounds or non-intact skin (open skin lesions or rash).
Wear for handling items or surfaces potentially contaminated with blood or
body fluids.
Gloves should be put on directly before the task for which gloves are
required.
Gloves must be removed and discarded immediately after the activity for
which they were used.
Hand hygiene must be done immediately prior to putting on gloves and
after removing gloves.
Gloves are not required for routine care when in contact with intact skin (e.g.
bathing, dressing the patient, taking blood pressure).
Gloves are not required to handle food trays and dishes.
Change gloves after touching a contaminated body site and before touching
a clean body site or the environment.
Do not wash or re-use single use gloves.
Sterile gloves are worn to protect the patient during aseptic procedures.
Disposable gloves are worn for tasks other than direct patient care (e.g.
laundry, working with chemicals, cleaners and disinfectants).
I.H. Facilities refer to the GLOVES, HAND HYGIENE AND YOU (NOT AVAILABLE TO
NON IH FACILITIES).
Wear to protect the mucous membranes of the nose, mouth and eyes during
procedures/activities likely to generate splashes of blood, body fluids,
secretions or excretions or within two metres of a coughing patient.
Change mask if it becomes wet.
Do not allow mask to hang or dangle around the neck.
Remove mask by using ties or elastic and discard mask promptly after use.
Remove and discard the eye protection after use if disposable; if re-usable,
clean with a disinfectant after each use.
The outside of the mask and eye protection are considered contaminated.
Clean hands after removing the mask and eye protection.
Do not re-use disposable masks.
Prescription eye glasses are not acceptable as eye protection.
Must be fit tested prior to wearing N95 respirator.
Wear when caring for patients on Airborne Precautions.
A single-use N95 mask must only be worn once.
Wear impermeable long sleeve gown to protect uncovered skin and prevent
soiling of clothing during activities likely to generate aerosolization of blood or
body fluids.
The gown/apron should be put on immediately before the task and must be
worn properly, i.e., tied at top and around the waist.
Gowns/aprons are SINGLE USE - remove promptly after use and discard in
appropriate receptacle. The outside of the gown/apron is considered
contaminated so hand hygiene must be done following removal.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 4
4.5
Environmental Controls
Measures implemented to reduce the risk transmission of infectious agents to patients and
healthcare providers; includes patient placement and transport, patient care equipment, cleaning
practices including laundry and dishes and engineering controls such as point-of-care sharps
containers and waste management.
Activity
Best Practice
Patient
Placement
▪
▪
▪
▪
Patient transport
Patient care
equipment
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Options include single patient rooms, two patient rooms and multi-bed
rooms/bays.
Single room with dedicated bathroom and sink preferred when there is a
potential for transmission of an infectious agent (i.e.) patients with
uncontrolled diarrhea
Maintain a spatial separation of at least 2 meters between coughing
patients and others in the room – draw the privacy curtain between beds.
Cohorting a group of patients (with same disease/organism) in the same
area is an option if single rooms are not available.
Patient’s gown/clothing is clean.
Patient has clean hands prior to going to another department.
Wounds are covered with clean, intact dressings.
Incontinence products are in place and intact when required.
Patients who are coughing need to wear a surgical/procedure mask.
ALL patient care equipment including transport equipment requires
cleaning and disinfection after each use.
Storage of contaminated equipment is to be in a designated area/container
– usually in a Soiled Utility Room.
Gross soil must be removed before the item can be cleaned and
disinfected.
Once items are cleaned and disinfected, they should be labeled as such,
and moved to a clean storage area.
Dedicate bedpans and commodes for single patient use. Clean and
disinfect before use by another patient.
Single use items are to be discarded, not reused.
Procedures should be established for assigning responsibility for routine
cleaning of all healthcare equipment.
Wear appropriate PPE when handling, cleaning and disinfecting soiled
equipment.
Personal care supplies are single patient use items and are NOT to be
shared (i.e.) soap, lotions and creams.
REFER TO IX0800 PERSONAL CARE SUPPLIES GUIDELINE
When using nursing bags in the Community settings, place soiled
equipment in impervious container and do not return it to the nursing bag.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 5
Activity
Best Practice
Environmental
cleaning
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Dishes
▪
▪
▪
▪
▪
Laundry
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
Sharps
▪
▪
▪
▪
▪
▪
High touch surfaces in patient care areas are cleaned and disinfected with a
hospital-grade disinfectant (quaternary ammonium compound or hydrogen
peroxide product) daily and more frequently if the risk of environmental
contamination is higher.
Floors are cleaned with a detergent product.
No “re-dipping” (double dipping) of cleaning cloths in the cleaning solutions.
Gloves should be worn during cleaning and disinfecting procedures.
Containers for liquid soap and ABHR are disposable and should not be
‘topped up’.
When a patient is discharged or transferred the room or bed space must be
cleaned and disinfected thoroughly before the next patient occupies the space.
Do not apply cleaning chemicals by aerosol or trigger sprays.
Tubs should be cleaned and disinfected after each use. Use cold water when
using the disinfectant and ensure contact time of the disinfectant with all
surfaces is for 10 minutes or as recommended by the manufacturer.
Use gloves when handling waste/garbage.
Place biohazardous waste (items saturated, dripping with blood) in appropriate
biomedical waste container in the soiled utility room.
Items that are broken, torn, cracked or malfunctioning need to be replaced.
Use commercial dishwashers or wash with hot water and detergent for ALL
dishes, including those used by patients on Additional Precautions.
Disposable dishes are not required.
Gloves are not required when transporting dirty dishes.
If Food Service Workers identify trays that contain bodily fluids or sharps, they
will bring this to the attention of the nursing staff.
ALL laundry is handled the same way, including those patients on Additional
Precautions.
Wear appropriate PPE when handling soiled laundry (i.e. gloves and if
necessary disposable gown or apron).
Position hamper/tote/laundry bag in room or as close to the room entrance as
possible.
Ensure that laundry is free of sharps, instruments, and patient‘s personal
belongings.
Excrement should removed manually, not by spraying with water.
Roll laundry carefully into itself. Avoid shaking or fluffing.
Dirty laundry is not to be placed on the bedside tables, floor or in the sink.
Place soiled laundry into leak proof bags.
Laundry bags should be tied securely and not over-filled.
Remove PPE after handling soiled linen and perform hand hygiene before
handling clean laundry.
Sharps disposal containers must be readily available in all areas.
Sharps must be discarded immediately after use, directly into a disposal
container at the point of use.
Do not recap needles.
Scalpel blades must be removed using forceps.
Never fill a sharps disposal container more that ¾ full.
Never leave a sharp protruding from the sharps disposal container.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 6
Activity
BEST PRACTICE
Waste
Management
Blood/body fluid
spills
REFER TO IF0300 WASTE MANAGEMENT GUIDELINE
▪
▪
▪
▪
4.6
Wear appropriate PPE.
Absorb excess fluid with paper towels and discard in biohazardous waste
container.
Clean area first, and then disinfect the area with an approved hospital
disinfectant.
Notify Housekeeping of large spills.
Administrative/Source Controls
Activity
BEST PRACTICE
Healthcare
Provider
Education
Patient Education
▪
Respiratory
Hygiene
▪
▪
▪
▪
▪
Visitors
▪
▪
▪
▪
Healthy
Workplace
Practices
▪
Aseptic
Technique
AerosolGenerating
Medical
Procedures
▪
▪
▪
▪
▪
Ongoing education includes hand hygiene, Point of Care Risk Assessment,
Routine Practices & Additional Precautions, cleaning & disinfection of the
environment and equipment and staff safety.
Includes hand hygiene, respiratory hygiene and not sharing personal care
items.
Post signs with instructions to patients and visitors on how to ‘cough/sneeze
into your sleeve’, ‘cover your cough’ with a tissue and promptly dispose of
used tissue, or put on a mask if the symptoms are uncontrollable or person
cannot comply with instructions.
Hand hygiene must be done following contact with respiratory secretions
including disposal of used tissues.
Maintain spatial separation, ideally more than 2 meters (6 feet) between
persons with respiratory symptoms in common areas, such as waiting rooms.
Healthcare providers to use and teach patients avoidance measures that
minimize contact with droplets when coughing or sneezing, such as: turning
the head away from others; covering the nose and mouth with tissue.
Should not enter the healthcare setting if they are sick or unable to comply
with hand hygiene and other precautions that might be required.
Should be instructed to do hand hygiene when entering and exiting the
patient’s room.
Encourage visitors to have annual influenza vaccine.
Provide visitor with information pamphlets located on the INFECTION
PREVENTION & CONTROL WEBSITE. (NOT AVAILABLE TO NON IH FACILITIES).
Staff not to come into work when ill with symptoms that are of an infectious
origin.
Provide appropriate immunizations to patients and healthcare providers
including annual influenza vaccine.
Use for handling medications and for procedures such as intravenous
catheterization, urinary catheterization, wound care, etc.
Only those needed to perform the procedure should be present in room.
Use Routine Practices including hand hygiene and appropriate PPE based
on the Point of Care Risk Assessment
Use Additional Precautions based on the Point of Care Risk Assessment and
potential for infectious disease diagnosis.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 7
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 8
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 9
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 10
5.0 REFERENCES
5.1.
Routine Practices and Additional Precautions for Preventing the Transmission of
Infection in Health Care; Public Health Agency of Canada; Sept 1, 2010 – Final Version.
5.2.
Routine Practices and Additional Precautions In all Healthcare Settings. Provincial
Infectious Diseases Advisory Committee (PIDAC), Ontario; July 2011.
5.3.
Best Practice for Environmental Cleaning for Prevention and Control of Infections in all
nd
Healthcare Settings. 2 Edition. Provincial Infectious Diseases Advisory Committee
(PIDAC), Ontario; May 2012.
APPENDIX A
Aerosol-generating medical procedures (AGMPS) - procedures that stimulate coughing and promote
generation of aerosols; examples include intubation and related procedures, manual ventilation, open
endotracheal suctioning, CPR, bronchoscopy, sputum induction, surgery, autopsy, and non-invasive
positive pressure ventilation (CPAP, BiPAP), high concentration oxygen therapy (50% or higher). For
diagnostic (but not therapeutic) bronchoscopy or sputum induction, use an N95 respirator, due to risk
from undiagnosed TB.
Aseptic Technique – preventative measures to reduce the risk of introduction of microorganisms
through a portal of entry including mucous membranes, intravenous catheterization, breaks in the skin,
urinary catheterization; methods of introduction include inhalation, injection, and puncture.
Cleaning – the physical removal of dirt, dust or foreign material. Cleaning usually involves soap and
water, detergents or enzymatic cleaners. Thorough cleaning is required before disinfection or
sterilization may take place.
Cohorting – the placement and care of patients in the same room, who are infected or colonized with the
same microorganism; or placing those who have been exposed together to limit risk of further
transmission.
Disinfection – removal and destruction of most pathogens (or disease-causing organisms) except
bacterial spores; requires friction (cleaning) and the use of a disinfectant product.
High touch areas/surfaces – are those that have frequent contact with hands and require more frequent
cleaning, particularly during outbreaks. Examples include doorknobs, elevator buttons, telephones, call
bells, bedrails, light switches, monitoring equipment, chair arms, faucet handles, over bed tables, hand
rails, flusher handle, soap and ABHR dispensers, paper towel holder and edges of privacy curtains.
Housekeeping Clean
 Terminal/Discharge Clean – refers to the process of cleaning and disinfection which is
undertaken upon discharge of a patient from a room. The patient room, cubicle, or bed space,
bed, bedside equipment, environmental surfaces, hand washing sink and bathroom should be
thoroughly cleaned before another patient is allowed to occupy the space.
 Isolation Terminal Clean – refers to the process of cleaning and disinfection which is
undertaken upon discharge of a patient from or discontinuation of any ‘Isolation Precautions’
(Additional Precautions). In addition to the Terminal/Discharge clean, privacy and shower
curtains are changed, toilet paper, paper towel, glove box and toilet brush should all be
discarded and replaced.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F – IF0100 (Routine Practices for All Care Areas)
Page 11
Non-critical Medical Equipment – equipment in the patient care environment that is used between
patients (e.g. imaging equipment, electronic monitoring equipment, commode chairs); items that touch
only intact skin but not mucous membranes.
N95 Respirator – type of mask used to prevent inhalation of small particles that may contain infectious
agents transmitted via the airborne route.
Personal Protective Equipment (PPE) – barriers placed between the infectious source and one’s own
mucous membranes, airways, skin and clothing to prevent exposure to blood and body fluids.
Point of Care Risk Assessment – a dynamic process done before each interaction with a patient or
their environment in order to determine which interventions are required to prevent transmission of
microorganisms during the interaction considering the patient’s status can change.
Respiratory Hygiene – personal practices that help prevent the spread of microorganisms that cause
respiratory infections; applies to any person entering a healthcare facility who has signs of illness,
including cough, congestion, runny nose or increased production of respiratory secretions.
Routine Practices – based on the assumption that all blood and body fluids contain potentially infectious
organisms, the same safe standards of practice should be used routinely with all patients to prevent
exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin or soiled
items and to prevent the spread of microorganisms.
Sharps – are devices that can cause occupational injury to healthcare providers (e.g. laceration or
puncture the skin). Some examples of sharps include needles, lancets, blades and clinical glass.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0200 (Hand Hygiene Guidelines)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IF0200:
Hand Hygiene Guidelines
EFFECTIVE DATE: September 2006
REVISED DATE: December 2012, November
2016
REVIEWED DATE: Sept 2014 July 2015
1.0
PURPOSE
Hand hygiene (hand cleaning) is the single most important procedure for preventing the spread of
healthcare associated infections.
2.0
DEFINITIONS
See the glossary in Appendix A for hand hygiene definitions.
3.0
GUIDING PRINCIPLES
3.1
Hand hygiene is known to reduce patient morbidity and mortality from healthcare associated
infections. It causes a significant decrease in the carriage of potential pathogens on the
hands.
Hand hygiene is the responsibility of ALL individuals involved in health care.
3.2
Hand sanitizing with an alcohol-based hand rub (ABHR) is the preferred method (when
hands are not visibly soiled) for cleaning hands.
3.3
There is standardized ABHR product placement in acute, residential and community areas
throughout IH :











At entrances to facilities
In waiting rooms
At entrances to units
In dining rooms
At entrance to each patient room
At entrance to soiled utility rooms, medication rooms, clean supply rooms
At point-of-care, within 3 feet of the patient bed, unless there are safety concerns (e.g.
psychiatry, residential)
Affixed to the mobile work carts such as vital sign carts, med carts, dressing carts, clean
linen carts, housekeeping carts, and others
ABHR that is attached to the wall must not be installed directly over a source of ignition
(i.e. electrical outlets). The risk of fire related to the use of ABHR is very small
Entrance to clean and soiled service rooms
In any location where personal protective equipment is donned or doffed
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0200 (Hand Hygiene Guidelines)
Page 2
3.4
Hand hygiene infrastructure

Sinks should be in adequate numbers and accessible to facilitate staff, patient and
visitor hand washing (CSA Z8000)

Best Practices for Hand Hygiene facilities and Infrastructure in Healthcare Settings
Checklist for all new projects and renovations – this checklist should be completed for
each facility every three years. This should be done jointly between plant services,
capital planning and infection prevention and control

Bar soaps are not recommended for use by healthcare providers

Disposable paper towels are readily available for drying hands

Healthcare workers will inform housekeeping if they see that the ABHR is empty

Hand hygiene products must be dispensed in single-use dispensers and discarded
when empty; containers must not be “topped-up” or refilled - this practice is not
acceptable since it can result in contamination of the container and product

ABHR’s should not be placed at, or adjacent to, hand washing sinks

Place ABHR according to CSA Z8000 specifications

Plain soap is used in all care settings for routine hand washing
3.5
The use of gloves is not a substitute for performing hand hygiene. Hand hygiene must be
performed before putting on gloves and after removing gloves.
3.6
When Clostridium difficile infection is suspected or diagnosed:

Wash hands with soap and water (preferred)

If no sink is in close proximity, clean hands with alcohol hand rub and wash with soap
and water at first opportunity

Do not perform hand hygiene at a patient sink, as this may cause recontamination of
the health care provider’s hands. Use a dedicated staff hand washing sink
3.7
The fingernails are the area of greatest contamination. Short nails are easier to clean and are
less likely to tear gloves. Artificial nails and nail enhancements have been implicated in the
transfer of microorganisms.

The areas of the hands that are often missed when performing hand hygiene are the
wrist creases, thumbs, fingertips, under the fingernails and under jewelry.

Dry or damaged skin conditions of the hands show a higher bacterial load, which is
more difficult to remove than with healthy, intact skin.
3.8
Compatibility between lotions and hand hygiene products, and lotion‘s potential effect on
glove integrity should be considered (i.e. lotions should not be petroleum based).
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0200 (Hand Hygiene Guidelines)
Page 3
4.0
PROCEDURE
4.1
4 Moments for Hand Hygiene
Reference: Government of Ontario (2006)
THE 4 MOMENTS FOR HAND HYGIENE IN HEALTHCARE:
1.
2.
3.
4.
4.2
BEFORE initial patient/patient environment contact
BEFORE aseptic procedure
AFTER body fluid exposure risk
AFTER patient/patient environment contact
Additional Moments for Hand Hygiene
 Before initial contact with a patient or items in their environment; this should be done on
entry to the room or bed space, even if the patient has not been touched.
 Before putting on gloves.
 Before preparing, handling or serving food or medications to a patient.
 After care involving contact with blood, body fluids, secretions and excretions of a patient,
even if gloves are worn.
 Immediately after removing gloves and before moving to another activity.
 When moving from a contaminated body site to a clean body site during healthcare
activities.
 After contact with a patient or items in their immediate surroundings when leaving the
area, even if the patient has not been touched.
 After using the toilet or after toileting others.
 After changing an incontinence product or a child’s diaper.
 Prior to using computers and other electronic devices.
 And… whenever in doubt.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0200 (Hand Hygiene Guidelines)
Page 4
4.3
Hand Hygiene Using Alcohol Based Hand Rub (ABHR)

Use routinely when hands are not visibly soiled.

Three steps for hand rub:
1. Apply product liberally to palms of hands.
2. Spread thoroughly over hands.
3. Rub until dry.
4.4
Hand Hygiene Using Soap and Water

Use when hands are visibly soiled.

Steps for hand washing with soap and water:
1.
Wet your hands with warm running water.
2.
Apply soap.
3.
Lather for 15 seconds.
4.
Rinse well with warm running water.
5.
Pat hands dry with a paper towel.
6.
Use the paper towel to turn off the taps.

If hands are visibly soiled and running water is not available, perform hand hygiene
using ABHR then immediately find a sink to wash with soap and water.
4.5
Hand Hygiene for Patients

Staff should encourage and assist patients to perform hand hygiene prior to eating,
when their hands are soiled, after toileting and before leaving their room or clinic area.

ABHR is available for patients to use at point of care.

It is okay for patients to ask their healthcare providers if they have performed hand
hygiene prior to providing direct care.
4.6
Surgical hand scrubs are performed in the operative setting
(http://inet.interiorhealth.ca/infoResources/clinresources/Documents/Surgical%20Scrub.pdf)
4.7
Hand Care

Hand care for staff is a key component of improving effective and safe hand hygiene
practices.

Provide staff education on the benefits of using ABHRs and appropriate hand hygiene
technique.

Provide staff with appropriate hand moisturizing skin care products.

To prevent skin damage from frequent hand hygiene, staff to moisturize hands
regularly by applying hand lotion from a pump dispenser

If you have an existing skin condition and /or suspected new skin condition that is
interfering with performing hand hygiene look for hand care information on the InsideNet
under Employee Health & Safety
4.8
Nails, Jewelry and Clothing:

Nails shall be kept clean and short (less than 3 mm) at all times - the nail shall not show
past the end of the finger.

Nail polish shall not be worn.

Artificial nails or nail enhancements shall not be worn by healthcare providers who
provide direct patient care.

Hand/wrist jewelry shall not be worn by healthcare providers who provide direct patient
care.

Watches shall be removed or pushed up above the wrist by healthcare providers who
provide direct patient care before performing hand hygiene.

Long sleeves should not interfere with, or become wet when performing hand hygiene.
If long sleeves are worn, push sleeves back prior to doing hand hygiene.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0200 (Hand Hygiene Guidelines)
Page 5
4.9
Other Impediments to Effective Hand Hygiene

Upper extremity support devices such as casts and splints, or complex bandages on
hands and forearms of healthcare workers may impede effective hand hygiene.

Staff that are unable to perform effective hand hygiene as per the 4 moments of hand
hygiene must report to their manager immediately – consultation with Workplace Health
and Safety may be necessary.
4.10
Education

IH will provide staff hand hygiene education, training, and competency assessment and
inform all healthcare providers of the hand hygiene policy at the time of hiring and
during orientation (AH0700 Hand Hygiene Administrative Policy).

The requirements to complete education/training are as follows:
Physicians – Yearly at the time of credentialing, physicians will complete the I-Learn
education module (course ID: module: 855, quiz: 856).
1. Direct Patient Care Staff – Education will be linked to performance rates of the
unit. Staff working on units with hand hygiene compliance less than 69% over a
one year period will be required to complete the I-Learn education module
(course ID: module:853, quiz: 854)
2. New Hires – At the time of their orientation.
3. Students – At the time of their orientation.



5.0
Provide education for patients, families and visitors including instructions regarding
when and how to perform hand hygiene – use information brochures, posters.
The hand hygiene pamphlet for patients, visitors, and families shall be at the bedside for
each new admission.
Routinely monitor healthcare provider hand hygiene compliance and provide timely
feedback for each quarter that a unit has less than 69% compliance using an action
plan with the goal of improving patient safety by increasing hand hygiene compliance
rates.
REFERENCES
5.1
AH0700 – Interior Health Administrative Hand Hygiene Policy.
5.2
Best Practices for Hand Hygiene In All Healthcare Settings and Programs. British
Columbia Ministry of Health; July 2012.
5.3
Best Practices for Hand Hygiene In all Healthcare Settings – 4 Edition. Provincial
Infectious Diseases Advisory Committee (PIDAC), Ontario;(2010).
http://www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf
5.4
APIC Text 2009.
5.5
World Health Organization (WHO) World Alliance for Patient Safety. WHO Guidelines on
Hand Hygiene in Health Care
http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
5.6
Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update
Source: Infection Control and Hospital Epidemiology, Vol. 35, No. 6 (June 2014), pp. 628-645
th
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0200 (Hand Hygiene Guidelines)
Page 6
APPENDIX A
Glossary
Alcohol-based Hand Rub (ABHR) – can be a liquid, gel, or foam formulation. ABHR’s are the preferred
method to routinely decontaminate hands in clinical situations when hands are not visibly soiled as they
provide for a rapid kill of most transient microorganisms, are less time-consuming than washing with soap and
water and are easier on skin. ABHR must contain between 70 - 90% alcohol. Can be used as a surgical
scrub.
Contamination: The presence of an infectious agent on hands or on a surface, such as clothing, gowns,
gloves, bedding, toys, surgical instruments, patient care equipment, dressings or other inanimate objects.
Direct Care: Provision of hands-on care (e.g. bathing, washing, turning patient, changing clothes, continence
care, dressing changes, care of open wounds/lesions, toileting).
Environment of the Patient: The immediate space around a patient that may be touched by the patient and
may also be touched by the healthcare provider when providing care. For example:
 In a single room, the patient environment is the room
 In a multi-bed room, the patient environment is the area inside the individual’s curtain and including
the curtain
 In an ambulatory setting, the patient environment is the area that may come into contact with the
patient within their cubicle
 In a nursery/neonatal setting, the patient environment includes the inside of the bassinette or isolette,
as well as the equipment outside the bassinette or isolette used for that infant (e.g. ventilator,
monitor)
Hand Care: Actions and products that reduce the risk of skin irritation. A hand care program for staff is a key
component of hand hygiene and includes hand care assessment, staff education and an occupational health
assessment.
Hand Hygiene: A general term referring to any action of hand cleaning. Hand hygiene relates to the removal
of visible soil and removal or killing of transient microorganisms from the hands. Hand hygiene for patient
care may be accomplished using an alcohol-based hand rub or soap and running water. Hand hygiene
includes surgical hand preparation.
Hand Hygiene Moment - points to a patient care activity during which hand hygiene is essential because the
risk of transmission of microorganisms is greatest. There may be several hand hygiene moments in a single
care sequence or activity.
Hand Washing: The physical removal of microorganisms from the hands using soap and running water.
Healthcare Provider (HCP): Any person working in the healthcare system. This includes, but is not limited
to, the following: emergency service workers, physicians, dentists, nurses, respiratory therapists and other
health professionals, personal support workers, clinical instructors, students, environmental and food
services, facility maintenance, contracted providers and home healthcare workers. In some settings,
volunteers might provide care and would be included as a healthcare provider.
Nail Enhancement: Nail enhancements refer to artificial nails, resin wraps, tips, acrylics, gems, sticker,
piercings or gels.
Occupational Health and Safety (OHS)/Workplace Health: Preventive and therapeutic health services in
the workplace provided by trained occupational health professionals, e.g. nurses, hygienists, and physicians.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0200 (Hand Hygiene Guidelines)
Page 7
Patient: The term ‘patient’ in this document refers to any patient, clients and residents receiving care within a
healthcare setting.
Plain Soap: Detergents that do not contain antimicrobial agents or that contain very low concentrations of
antimicrobial agents that are present only as preservatives.
Point-of-Care: The place where three elements occur together: the patient, the healthcare provider and care
or treatment involving patient contact. Point-of-care products should be accessible to the healthcare provider,
within arm’s reach, without the provider leaving the zone of care.
Surgical hand preparation: The preparation of hands for surgery, using either antimicrobial soap and water
or an alcohol-based hand rub, preferably one with sustained antimicrobial activity.
Visibly Soiled Hands: hands on which dirt or body fluids can be seen.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0300 (Waste Management)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IF0300:
Waste Management
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
December 2012, March 2013
REVIEWED DATE:
1.0
PURPOSE
To prevent the spread of infection, reduce the risk associated with waste disposal and ensure the safety
of the general public, patients and healthcare providers in regards to waste disposal processes.
2.0
DEFINITION
See the glossary in Appendix A for hand hygiene definitions.
3.0
GUIDING PRINCIPLES
3.1.
Written procedures for the management of biomedical waste from healthcare settings should be
developed based on provincial and municipal regulations and legislation.
3.2.
All staff handling waste or garbage will wear personal protective equipment
including protective gloves.
3.3.
Waste should be segregated according to the categories listed in the table below. Waste
from several different categories should not be mixed in one bag. NOTE: Placing
regular waste that does not require special disposal will result in increased cost and may
incur penalties from collection agencies.
WASTE TYPE
Anatomical
waste –
placentas,
human tissue,
organs and body
parts
Microbiology
Laboratory
waste autoclaved
waste
Fluid waste pleurevacs,
hemovacs, blood
bags, suction
liners/containers
with visible
blood, etc.
COLOUR-CODING
Red
STORAGE/DISPOSAL
Commercial BioMedical Waste
Disposal - incinerated
White Bucket
Landfill
Yellow
Commercial BioMedical Waste
Disposal
Note: in this document the term “patient” is inclusive of patient, resident or client.
*Contents of drainable devices
can be emptied into the sewer.
Infection Prevention and Control
Section 03F - IF0300 (Waste Management)
Page 2
Sharps –
needles, sutures,
lancets, blades,
trocars,
contaminated
scissors, razors
or clinical glass
General waste disposable
suction
containers with
no visible blood,
dressings,
sponges, diapers,
incontinent pads,
PPE, disposable
drapes, dialysis
tubing and filters,
empty IV bags
and tubing,
catheters, empty
specimen
containers,
disposable lab
coats and aprons
and pads that will
not release liquid
or semi-liquid
blood if
compressed, etc.
Yellow
Commercial
Sharps
Containers
Commercial BioMedical Waste
Disposal
Black bag **
Landfill – Regular Garbage
Disposal **
** FOLLOW LOCAL LANDFILL REGULATIONS.
3.4.
Plastic waste holding bags are color coded and sturdy enough to resist puncture under conditions of
use and to the point of disposal. Use the Soiled Utility Room to gather together disposable
biomedical waste.
Safe Sharps Handling
Use safety engineered medical devices, such as needleless devices.
NEVER re-cap a used needle.
NEVER reach into waste or sharps containers.
Provision of rigid, puncture-resistant sharps containers at or near the point-of-use to permit
safe one-handed disposal required.
Handle laundry with care.
Educate staff about the risks associated with sharps, including safe disposal of sharps in
puncture-resistant containers if found in the environment (e.g. sharps in laundry, waste,
bedside, floor).
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0300 (Waste Management)
Page 3
4.0
PROCEDURE
4.1.
Use appropriate PPE when handling waste/garbage including puncture resistant
gloves.
4.2.
Ensure bags are not torn, are securely closed and no sharp objects are protruding
through.
4.3.
It is not necessary to double bag garbage unless the first bag is leaking.
4.4.
Human blood & body fluid waste can be disposed of from drainable devices into a sanitary sewer
and does not require special treatment before disposal. When handling these fluids care must
be taken to eliminate spills and the formation of aerosols.
4.5.
Place all general waste into the regular garbage containers.
4.6.
Place Biomedical waste into appropriate containers.
4.7.
SHARPS

Choose the correct size/shape of sharps container for the situation
(e.g.) small closable container for Home/Community care.

Staff responsible for collecting and replacing sharps containers should
be trained in proper handling methods.

All SHARPS containers must have an approved biohazard waste
label.

Place all sharp items in an approved sharps container.

DO NOT over fill sharps containers.
4.8.
BLOOD & BLOODY BODY FLUID SPILLS





4.9.
Wear appropriate personal protective equipment to clean up spills (e.g.) gloves, gown and
face shield if there is a danger of splashing.
Clean the area - gross soil must be removed prior to cleaning and disinfecting
o
Use paper towels for small spills, mop for large spills.
o
Used paper towels should be placed in biohazardous waste container.
o
Mop heads should be placed in laundry bags.
Disinfect area with approved hospital disinfectant.
Cleaning equipment/reusable gloves are to be cleaned/discarded appropriately.
Hands must be washed at the end of the procedure.
BIOMEDICAL WASTE DISPOSAL IN COMMUNITY CARE
 Follow Biomedical Waste Disposal – Community Care guidelines
http://inet.interiorhealth.ca/infoResources/clinresources/Documents/Biomedical%20Waste%2
0in%20Community%20Care.pdf
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 03F - IF0300 (Waste Management)
Page 4
APPENDIX A
Glossary
Anatomical Waste – placentas, human tissues, organs and body parts; does not include teeth, hair and
nails.
Biomedical waste – waste that requires additional precautions due to potential infectious nature;
includes anatomical waste, fluid waste, sharps, microbiology laboratory waste and sharps as defined in
APPENDIX A.
Drainable devices – any device that can have its liquid contents evacuated or drained out.
Fluid Waste – human fluid blood and blood products, items saturated or dripping with blood, body fluids
contaminated with blood and body fluids removed for diagnosis during surgery, treatment or autopsy;
does not include urine or feces.
General Waste – includes items such as dressings, sponges, diapers, incontinent pads, PPE,
disposable drapes, dialysis tubing and filters, empty IV bags and tubing, catheters, empty specimen
containers, disposable lab coats and aprons and pads that will not release liquid or semi-liquid blood if
compressed.
 Includes waste from Contact, Droplet and Airborne Precautions rooms.
 Includes waste from offices, kitchens, washrooms, public areas.
Microbiology Laboratory Waste - laboratory cultures, stocks or specimens of microorganisms, live or
attenuated vaccines, human or animal cell cultures used in research including laboratory material that
has come into contact with any of these.
Non drainable and/or Single Use devices – any device that is not able to have its liquid contents
drained out or are meant to be used once and then the device discarded.
Personal Protective Equipment (PPE) – barriers used by healthcare providers to protect mucous
membranes, airways, skin, and clothing from exposure to blood and body fluids. Can include gloves,
mask, eye protection or gown, as needed.
Sharps – items capable of cutting or puncturing the skin and that have come into contact with blood,
body fluids or microorganisms – items include all needles and devices containing needles or spikes,
broken medical glassware, contaminated scalpel blades, scissors, razors, lancets.
5.0
REFERENCES
5.1
Canadian Council of Ministers of the Environment (CCME) Guidelines for the Management of
Biomedical Waste in Canada. CCME-EPC-WM-42E. February 1992.
5.2
Best Practices for Environmental Cleaning for Prevention and Control of Infections In
All Health Care Settings - 2nd edition. Provincial Infectious Diseases Advisory Committee
(PIDAC), Ontario; May 2012.
5.3
City of Kelowna. (2012). Solid Waste Management Regulation Bylaw Number 10106.
February 13, 2012.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0100 (Additional Precaution for All Care Areas-Transmission Tables)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IH0100:
1.0
Additional Precautions For
All Care Areas
EFFECTIVE DATE: September 2006
Transmission Tables
REVIEWED DATE:
REVISED DATE: November 2010,
December 12, 2012, January 2015
PURPOSE
Additional Precautions are interventions used in addition to Routine Practices to prevent
transmission of certain microorganisms to patients and healthcare providers by interrupting
transmission of infectious agents that are suspected or identified in a patient.
Routine practices properly and consistently applied should prevent transmission by the contact and
droplet routes.
For certain situations that may result in extensive contamination of the environment or for
microorganisms with a very low infectious dose, additional precautions may be indicated. These
include contact, droplet and airborne precautions.
The Transmission Tables identify the transmission characteristics and precautions by
condition/clinical presentation or by a specific etiology. This information guides the healthcare
provider in determining when to implement and discontinue additional precautions – implementation
should occur as soon as disease or risk factors are suspected or identified. A confirmed diagnosis is
not necessary for additional precautions to be applied.
Table 9 identifies the additional precautions that should be used for conditions and/or clinical
presentations of patients.
Table 10 identifies the additional precautions that should be used for specific etiologies identified –
that is the causative microorganism has been identified.
Note: in this document the term “patient” is inclusive of patient, resident or client.
2 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
PART C: TRANSMISSION CHARACTERISTICS AND PRECAUTIONS
Table 9: Transmission characteristics and precautions by condition/clinical presentation. Once
specific etiology is known, refer to Table 10
Condition/
clinical presentation
Potential pathogens
Precautions
Infective material
Route of
transmission
Duration of
precautions
Comments
Abscess
See draining wound
Bronchiolitis
Burns, infected
See draining wound
Cellulitis
Draining: See draining
wound
Periorbital in child
<5 years old without
portal of entry
Cold
Conjunctivitis
Cough, fever, acute
upper respiratory tract
infection
RSV, human metapneumovirus
parainfluenza virus, influenza,
adenovirus
Droplet and contact
Respiratory secretions
Large droplet and
direct and indirect
contact
Duration of symptoms
H. influenzae type B in nonimmune child <2 years of age;
Streptococcus pneumoniae,
Group A Streptococcus,
S. aureus, other bacteria
Droplet if
H. influenzae type B
is possible cause,
otherwise routine
practices
Respiratory secretions
Large droplet, direct
contact
Rhinovirus, RSV, human
metapneumovirus,
parainfluenza, adenovirus,
coronavirus
Adenovirus, enterovirus,
chlamydia, Neisseria
gonorrhea, other microbial
agents
Rhinovirus, RSV, human
metapneumovirus
parainfluenza, influenza,
adenovirus, coronavirus,
pertussis
Droplet and contact
Respiratory secretions
Large droplet and
direct and indirect
contact
Until 24 hours of
appropriate
antimicrobial therapy
received or if
H. influenzae type B
ruled out
Duration of symptoms
Contacta
Eye discharge
Direct and indirect
contact
Droplet and contact
Respiratory secretions
Large droplet, direct
and indirect contact
Patient should not share
room with high-risk
roommates
Patient should not share
room with high-risk
roommates
Until viral etiology ruled aRoutine if non-viral
out; duration of
symptoms, up to 14
days if viral
Duration of symptoms
Consider fever and
or until infectious
asthma in child <2 years
etiology ruled out
old as viral infection
Patient should not share
room with high-risk
roommates
3 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Condition/
clinical presentation
Potential pathogens
Cough, fever, pulmonary Mycobacterium tuberculosis
infiltrates in person at risk
for TB
Precautions
Airborne
Infective material
Route of
transmission
Duration of
precautions
Respiratory secretions
Airborne
Parainfluenza, influenza, human Droplet and contact
metapneumovirus, RSV,
adenovirus
Respiratory secretions
Large droplet, direct
and indirect contact
Many (bacteria, virus, fungus)
Contact
Pus
Direct and indirect
contact
Desquamation, extensive S. aureus
See draining wound
Diarrhea
See gastroenteritis
Acute diarrhea of likely
infectious cause
Draining wounds
S. aureus, Group A
Streptococcus, many other
bacteria
Contact
Pus
Direct and indirect
contact
Routine
Contact:b Major
wound, dropletc
Pus
Direct and indirect
contact
Duration of drainage
Encephalitis
ADULT: Routined
PAEDIATRIC:
Contactd
Feces, respiratory
secretions
Direct and indirect
contact (fecal/oral)
Until specific etiology
established or until
enterovirus ruled out
Croup
Decubitius (pressure
ulcer, draining)
See draining wound
Dermatitis
See draining wound
Multiple microbial agents
including herpes simplex virus
(HSV), enterovirus, arbovirus
(West Nile virus)
Until infectious TB is
ruled out
Until patient has
received 2 weeks of
effective therapy, and
is improving clinically,
and has 3 consecutive
sputum smears
negative for acid fast
bacilli collected 8–24
hours apart
If multi-drug-resistant
TB, until sputum
culture negative
Duration of symptoms
or until infectious cause
ruled out
Comments
TB in young children is
rarely transmissible
Assess visiting family
members for cough
http://www.phacaspc.gc.ca/tbpclatb/pubs/tbstand07eng.php
Patient should not share
room with high-risk
roommates
Until infectious etiology If compatible with scabies,
take appropriate
ruled out
precautions pending
diagnosis
Until contained or
infection ruled out
b
Major: drainage not
contained by dressing
c
Droplet for first 24 hours
of antimicrobial therapy if
invasive group A
streptococcal infection
suspected
d
May be associated with
other agents including
measles, mumps,
varicella. If identified, take
appropriate precautions
for associated disease
4 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Condition/
clinical presentation
Potential pathogens
Precautions
Infective material
Route of
transmission
Routine unless signs
of toxic shocke
H. influenzae type B;
Possible in non-immune
infant <2 years of age, group A
Streptococcus, S. aureus
Droplet if
H. influenzae type B
is possible cause,
otherwise routine
Erysipelas
Draining: See draining
wound
Febrile respiratory illness
Usually present with
symptoms of a fever
greater than 38 °C and
new or worsening cough
or shortness of breath
Group A Streptococcus
Routine
Wide range of droplet-spread
respiratory infections, such as
colds, influenza, influenza-like
illness and pneumonia
Contact and droplet
precautions
Respiratory secretions
Fever without focus
(acute, in children)
Enterovirus and other
pathogens
ADULT: Routinef
PAEDIATRIC:
Contact
Feces, respiratory
secretions
Direct or indirect
contact (fecal/oral)
Food poisoning
Bacillus cereus, Clostridium
perfringens, S. aureus,
Salmonella, Vibrio
parahaemolyticus, Escherichia
coli O157, Listeria and others
ADULT: Routineg
PAEDIATRIC:
Contact
Food; feces if
Salmonella or
Escherichia coli O157
Foodborne, or direct
and indirect contact
(fecal/oral)
Furuncles
See draining wound
S. aureus
Enterocolitis
See diarrhea
Epiglottitis
In child <5 years old
Comments
e
Group A Streptococcus; many
other bacteria
Endometritis
Duration of
precautions
Contact and droplet for
the first 24 hours of
antimicrobial therapy if
invasive group A
Streptococcus suspected.
Respiratory secretions
Large droplet, direct
contact
Until 24 hours of
appropriate
antimicrobial therapy
received or until
H. influenzae type B
ruled out
Duration of symptoms
or until enteroviral
infection ruled out
Note: elderly people and
people who are
immunocompromised may
not have a febrile
response to a respiratory
infection
See Ontario Best
Practices for Preventing
Acute Respiratory
Infection in All Health
Care Settings
f
If findings suggest a
specific transmissible
infection, take precautions
for that infection pending
diagnosis
g
Consider contact
precautions for incontinent
adults if stool cannot be
contained or for adults
with poor hygiene who
contaminate their
environment
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
5 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Condition/
clinical presentation
Potential pathogens
Precautions
Infective material
Route of
transmission
Duration of
precautions
Gas gangrene
Draining: See draining
wound
Gastroenteritis
Clostridium spp.
Diarrhea and/or vomiting due to
infection or toxin
ADULT: Contacth
PAEDIATRIC:
Contact
Feces
Direct and indirect
contact (fecal/oral)
Duration of symptoms
for C. difficile,
norovirus, rotavirus
until ruled out. In
pediatrics, until normal
stools or infectious
etiology ruled out
Gingivostomatitis
HSV, other causes including
radiation therapy,
chemotherapy, idiopathic
(aphthous)
Some cases associated with
infection (e.g., campylobacter)i
Contact if primary
and extensive HSV
related.
Otherwise routine
Mucosal lesions
Direct contact
While lesions present
Hand, foot and mouth
disease
Enterovirus
ADULT: Routine
PAEDIATRIC:
Contact
Feces, respiratory
secretions
Direct and indirect
contact (fecal/oral)
Hemolytic-uremic
syndrome
Some associated with E. coli
O157
ADULT: Routinej
PAEDIATRIC:
Contact
Feces
Direct and indirect
contact (fecal/oral)
Guillain-Barré syndrome
Comments
h
Use contact precautions
until C. difficile, norovirus,
rotavirus ruled out.
Consider contact
precautions for incontinent
adults if stool cannot be
contained or for adults
with poor hygiene who
contaminate their
environment
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
See Table 10 for specific
etiologies
i
Take precautions as
appropriate for known or
suspected associated
infection
Duration of symptoms
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
Until E. coli O157 ruled jConsider contact
out
precautions for incontinent
adults if stool cannot be
contained or for adults
with poor hygiene who
contaminate their
environment
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
6 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Condition/
clinical presentation
Potential pathogens
Precautions
Infective material
Route of
transmission
Duration of
precautions
Hemorrhagic fever
acquired in appropriate
endemic or epidemic
area
Ebola, Lassa, Marburg,
Crimean-Congo and others
Contact and droplet
AGMPk
Blood and bloody body
fluids; respiratory
secretions; skin if Ebola
and urine if Lassa
Direct and indirect
contact; possibly
aerosol if pneumonia
Lassa: Sexual contact
Duration of symptoms
or until hemorrhagic
fever virus ruled out
Hepatitis of unknown
etiology
Hepatitis A, B, C, E viruses,
Epstein-Barr virus and others
ADULT: Routinel
PAEDIATRIC:
Contact
Feces; blood and
certain body fluids
Mucosal or
percutaneous
exposure to infective
body fluids
Sexual transmission
Vertical; mother to
child
Direct and indirect
contact (fecal/oral) for
hepatitis A, E
For 7 days after onset
of jaundice or until
hepatitis A and E
epidemiologically
excluded
Herpangina
Enterovirus
ADULT: Routine
PAEDIATRIC:
Contact
Feces, respiratory
secretions
Direct and indirect
contact (fecal/oral)
Duration of symptoms
Impetigo
See draining wound
Influenza-like illness
Group A Streptococcus,
S. aureus
Influenza, other respiratory
viruses
Contact and droplet
Respiratory secretions
Large droplet, direct
and indirect contact
Duration of symptoms
or until infectious
etiology ruled out
Kawasaki disease
(mucocutaneous lymph
node syndrome)
Meningitis
Unknown
Routine
Bacterial: Neisseria
meningitidis, H. influenzae
type B possible in non-immune
infant <2 years of age,
Streptococcus pneumoniae,
Group B Streptococcus, Listeria
monocytogenes, E. coli and
other Gram-negative rods
ADULT: Droplet until Respiratory secretions
Neisseria
meningitidis ruled
out, otherwise
routine
PAEDIATRIC: Droplet
and contactm
Mycobacterium tuberculosis
Routinen
Comments
Local public health
authorities should be
notified immediately
k
If AGMP necessary, see
strategies to reduce
aerosol generation, see
Part B, Section IV,
subsection iii, 1b
l
Consider contact
precautions for incontinent
adults if stool cannot be
contained or for adults
with poor hygiene who
contaminate their
environment unless
hepatitis A and E are
epidemiologically
excluded
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
Not known to be
transmissible
Large droplet, direct
contact
Until 24 hours of
appropriate
antimicrobial therapy
received
m
Pediatrics: precautions
for both bacterial and viral
until etiology established.
Droplet if viral etiology
established
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
n
Rule out associated
respiratory TB
7 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Condition/
clinical presentation
Potential pathogens
Precautions
Viral: enterovirus, arboviruses
ADULT: Routineo
PAEDIATRIC:
Contacto
Fungus
Unknown, probably many
organisms
Infective material
Route of
transmission
Duration of
precautions
Comments
Until enterovirus ruled
out
o
Routine
Routinep
Duration of symptoms
p
H. influenzae type B possible in
non-immune infant <2 years of
age, S. aureus, other bacteria
ADULT: Routine
PAEDIATRIC: Droplet
if H. influenzae
type B possible;
otherwise routine
Until 24 hours of
effective antimicrobial
therapy or until
H. influenzae type B
ruled out
Bordetella pertussis, Bordetella
parapertussis
Droplet
Respiratory secretions
Large droplets
Until pertussis ruled out
or 3 weeks after onset
of paroxysmals if not
treated or until 5 days
of antimicrobial therapy
received
Pharyngitis
Group A Streptococcus, viral,
Corynebacterium diphtheriae
Droplet and contact
Respiratory secretions
Direct and indirect
contact; large droplets
Pleurodynia
Enterovirus
ADULT: Routine
PAEDIATRIC:
Contact
Feces, respiratory
secretions
Direct and indirect
contact (fecal/oral)
Duration of symptoms;
if Group A
Streptococcus until 24
hours of antimicrobial
therapy received
Duration of symptoms
Necrotizing enterocolitis
Osteomyelitis
Otitis, draining
See draining wound
Paroxysmal cough,
suspected pertussis
Feces, respiratory
secretions
Direct or indirect
contact
May be associated with
measles, mumps,
varicella, HSV. If
identified, take
appropriate precautions
for associated disease
Unknown if transmissible
Take precautions if
outbreak suspected
Close contacts (household
and HCWs) may need
chemoprophylaxis and/or
immunization
If HCWs immunization not
up to date, refer to OH
and/or delegate Refer to
Canadian Immunization
Guide 7th Ed., 2006 for
specific information
available at:
http://www.phacaspc.gc.ca/publicat/ciggci/index-eng.php
If diphtheria suspected,
see Table 10.
Contact precautions apply
to children who are
incontinent or unable to
comply with hygiene
8 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Condition/
clinical presentation
Potential pathogens
Precautions
Infective material
Route of
transmission
Duration of
precautions
Comments
Pneumonia
ADULT: Routineq
Viruses, pertussis,
Respiratory secretions
PAEDIATRIC: Droplet
Mycoplasma, Streptococcus
and contact
pneumoniae, H. influenzae
type B, S. aureus, group A
Streptococcus, Gram-negative
enteric rods, Chlamydia,
Legionella, Pneumocystis, other
fungi; other agents
Large droplets, direct
and indirect contact
Until etiology
established, then as for
specific organism; no
special precautions for
pneumonia unless
ARO, then use Contact
Pseudomembranous
colitis
Rash compatible with
scabies
C. difficile
Contact
Feces
Duration of symptoms
Sarcoptes scabiei
Contact
Mites
Direct and indirect
contact (fecal/oral)
Direct and indirect
contact
Rash (maculopapular)
with fever and one of
coryza, conjunctivitis or
cough
Rash (petechial/purpuric)
with fever
Measles
Airborne
Respiratory secretions
Airborne
If confirmed, until 4
days after onset of rash
Neisseria meningitidis
Droplet if N.
Respiratory secretions
meningitidis
suspected, otherwise
routine
Large droplets, direct
contact
Rash (vesicular) with
fever
Rash, vesicular/pustular
in appropriate
epidemiologic context
until smallpox,
disseminated vaccinia
and monkeypox ruled out
Varicella
Airborne and contact Respiratory secretions, Airborne, direct and
skin lesion drainage
indirect contact
Contact, droplet and Lesions and respiratory
airborne
secretions
(monkeypox)
Skin lesion exudate,
oropharyngeal
secretions (smallpox,
disseminated vaccinia)
Discontinue if Neisseria
meningitidis ruled out
If N. meningitidis
confirmed, until 24
hours of appropriate
antimicrobial therapy
received
If confirmed, until all
See varicella, Table10
lesions are dry
Reye’s syndrome
May be associated with viral
infection, especially influenza,
varicella
Scalded skin syndrome
(Ritter`s Disease)
Smallpox, disseminated
vaccinia, monkeypox
If confirmed, until 24
hours after initiation of
appropriate therapy
q
Routine for adults unless
clinical, epidemiologic or
microbiologic data to
necessitate contact and
droplet precautions (i.e.,
on contact and droplet for
viral etiologies)
Minimize exposure of
immunocompromised
patients, patients with
chronic cardiac or lung
disease, neonates
Until 72 hours after stool is
normal.
For typical scabies,
routine (use gloves and
gown for direct patient
contact only)
See scabies, Table 10
See measles, Table 10
Precautions for known or
suspected associated viral
infection
Routine
9 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Condition/
clinical presentation
Septic arthritis
Severe respiratory illness
See febrile respiratory
illness
Skin infection
See cellulitus
Toxic shock syndrome
Urinary tract infection
Vincent’s angina, Trench
mouth
Wound infection
See draining wound
Potential pathogens
Precautions
Infective material
Route of
transmission
H. influenzae type B possible in
non-immune infant <2 years of
age; S. aureus, Streptococcus
pneumoniae, group A
Streptococcus, N gonorrhoea,
other bacteria
ADULT: Routine
Respiratory secretions Large droplet, direct
PAEDIATRIC: Droplet for H. influenzae type B contact H. influenzae
type B
if H. influenzae
type B possible;
otherwise routine
S. aureus, Group A
Streptococcus
Dropletr
Routine
Many
Multiple bacteria
Routines
Routine
Duration of
precautions
Comments
Until 24 hours of
appropriate
antimicrobial therapy
received or until
H. influenzae type B
ruled out
r
Droplet for first 24 hours
of antimicrobial therapy if
invasive group A
streptococcal infection
suspected
See draining wound if
drainage or pus
s
Contact if ARO
10 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Table 10: Transmission characteristics and precautions by specific etiology(15;492;497)
Microorganism
Clinical
presentation
Precautions
Routine
Cervicofacial,
thoracic or
abdominal
infection
Adenovirus
Respiratory tract Droplet and
Respiratory strains infection
contact
(pneumonia)
Infective
material
Actinomycosis
(Actinomyces sp.)
Route of
transmission
Incubation
period
Variable
Period of
communicability
Duration of
precautions
Not person to
person
Normal flora; infection usually
secondary to trauma.
Respiratory
secretions
Large droplets; 1–10 days
direct and
indirect contact
Shortly before
and until
symptoms cease
Duration of
symptoms
Late in
incubation period
until 14 days
after onset
Until symptoms
cease
Duration of
symptoms, up
to 14 days
Duration of cyst
excretion
Duration of
symptoms
Conjunctivitis
Contact
Eye discharge
Direct and
5–12 days
indirect contact
Adenovirus
Enteric strains
Diarrhea
ADULT:
Routinea
PAEDIATRIC:
Contact
Feces
Direct and
3–10 days
indirect contact
(fecal/oral)
Amebiasis
(Entamoeba
histolytica)
Dysentery and
liver abscess
ADULT:
Routineb
PAEDIATRIC:
Contact
Feces
Direct and
2–4 weeks
indirect contact
(fecal/oral)
Anthrax
(Bacillus
anthracis)
Cutaneous,
pulmonary
Routine
1–7 days;
maybe up to
60 days
Not person-toperson
Comments
Duration of
symptoms
Different strains responsible for
respiratory and gastrointestinal
disease
Patient should not share room with
high-risk roommates
Minimize exposure of
immunocompromised patients,
patients with chronic cardiac or lung
disease, neonates.
Symptoms may be prolonged in
immunocompromised patients
Careful attention to aseptic technique
and reprocessing of ophthalmology
equipment to prevent epidemic
keratoconjunctivitis
a
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
b
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Acquired from contact with infected
animals and animal products
Inhalation anthrax may occur as a
result of occupational exposure to
anthrax spores or as a result of
bioterrorism
Decontamination and postexposure
prophylaxis necessary for exposure to
aerosols in laboratory exposures or
biological terrorism
11 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Antimicrobialresistant
organisms (AROs)
Includes MRSA,
VRE,-resistant
Gram-negative
rods and other
organisms, as per
ICP
Infection or
colonization
(i.e.,
asymptomatic)
of any body site
Contactc
Infected or
colonized
secretions,
excretions
Variable
Direct and
indirect contact
Variable
Arthropod borne
virusd
(arboviruses)
Encephalitis,
fever, rash,
arthralgia,
meningitis
Routine
Blood, tissues
Vector-borne
(spread by
mosquitoes,
ticks)
Not person to
person except
rarely by blood
transfusion or
organ
transplantation
Ascariasis
(Ascaris
lumbricoides)
(roundworm)
Aspergillosis
(Aspergillus spp.)
Usually
asymptomatic
Routine
Not person to
person
Routine
Skin, lung,
wound or central
nervous system
infection
Not person to
person
Avian influenza
See influenza
Precautions
Infective
material
Route of
transmission
Incubation
period
3–21 days
(varies with
different
arboviruses)
Period of
communicability
Duration of
precautions
As directed by
ICP
Comments
c
Contact precautions for acute care
(for the purpose of this document,
acute care includes ambulatory care
settings such as hospital emergency
departments, and free-standing or
facility-associated ambulatory (day)
surgery or other invasive day
procedures (e.g., endoscopy units,
hemodialysis, ambulatory wound
clinics)
When symptomatic, precautions
should be determined on a case by
case basis as per ICP
When asymptomatic, precautions not
necessary in LTC, ambulatory,
prehospital and home care
See Appendix VI, 2. ARO
See IP&C Measures for HCWs in All
Healthcare Settings –
Carbapenaemase-resistant Gramnegative bacilli at:
http://www.phac-aspc.gc.ca/noissinp/guide/pubs-eng.php
d
Over 100 different viruses, most
limited to specific geographic areas
In North America: West Nile is most
common; others include California,
St. Louis, Western equine, Eastern
equine, Powassan, Colorado tick,
Snowshoe hare, Jamestown Canyon
Ova must hatch in soil to become
infective.
Spores in dust; infections in
immunocompromised patients may
be associated with construction
12 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Astrovirus
Clinical
presentation
Diarrhea
Babesiosis
Bacillus cereus
Bed bugs
(Cimex lectularius)
Blastomycosis
(Blastomyces
dermatitidis)
Bocavirus
Respiratory tract
infection
Botulism
(Clostridium
botulinum)
Brucellosis
(Brucella sp.)
Undulant, Malta or
Mediterranean
fever
Food poisoning
Nausea,
vomiting,
diarrhea,
abdominal
cramps
Allergic
reactions and
itchy welts.
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
ADULT:
Routinee
PAEDIATRIC:
Contact
Feces
3–4 days
Direct and
indirect contact
(fecal/oral)
Duration of
symptoms
Routine
Blood
Tick borne
Not person to
person, except
rarely by blood
transfusion from
asymptomatic
parasitaemic
donors
Routine
Duration of
symptoms
Comments
e
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Foodborne
Routine
Pneumonia, skin Routine
lesions
Not person to
person
Droplet and
contact
Flaccid
Routine
paralysis; cranial
nerve palsies
Systemic
Routine
bacterial
disease of acute
or insidious
onset
Duration of
precautions
Not known to transmit disease
If necessary, consult professional
pest control for infestation
For information see:
http://www.cdc.gov/nceh/ehs/publicati
ons/bed_bugs_cdcepa_statement.htm
Acquired from spores in soil
May cohort if infected with same virus
Patient should not share room with
high-risk roommates
Foodborne
Not person to
person
Weeks to
months
Not transmitted
person to person,
except rarely via
banked
spermatozoa and
sexual contact
Acquired from contact with infected
animals or from contaminated food,
mostly dairy products
Brucella is hazardous to laboratory
workers. Notify laboratory if diagnosis
is suspected
Prophylaxis necessary following
laboratory exposure
13 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Infective
material
Route of
transmission
MINOR:
Routine
MAJOR:
Contactf
Contactg
Drainage from
open lesions
Possibly direct
contact
Gastroenteritis
ADULT:
Routineh
PAEDIATRIC:
Contact
Contaminated
food, feces
Many
Routine
Draining lesions
Burkholderia
cepacia
Caliciviruses
See Noroviruses
Campylobacter
Candidiasis
(Candida sp.)
Cat scratch
disease
(Bartonella
henselae)
Chancroid
(Haemophilus
ducreyi)
Chickenpox
See varicella
Chlamydia
trachomatis
Chlamydia
pneumoniae
Exacerbation of
chronic lung
disease in
patients with
cystic fibrosis
Precautions
Incubation
period
Direct and
2–5 days
indirect contact
(fecal/oral)
Fever,
Routine
lymphadenopath
y
Period of
communicability
Duration of
excretion
Person–toperson
uncommon
16–22 days
Not person to
person
Sexual
transmission
3–5 days
Until healed and
as long as
infectious agent
persists in the
original lesion
Genital ulcers
Routine
Urethritis,
cervicitis, pelvic
inflammatory
disease;
neonatal
conjunctivitis,
infant
pneumonia;
trachoma
Pneumonia
Routine
Conjunctival
and genital
secretions
Sexual
transmission
Mother to child
at birth
Trachoma:
direct/indirect
contact
Variable
As long as
organism present
in secretions
Routine
Respiratory
secretions
Unknown
Unknown
Unknown
Duration of
precautions
Comments
Duration of
drainage
f
Until organism
cleared as
directed by
ICP
B. cepacia can result in respiratory
tract colonization or infection in
patient with cystic fibrosis
g
If other cystic fibrosis patients are on
the unit
All interactions with other cystic
fibrosis patients should be avoided
Duration of
symptoms
h
MAJOR: Contact precautions
necessary only if wound drainage
cannot be contained by dressings
Consider contact precautions for
adults if stool cannot be contained or
for adults with poor hygiene who
contaminate their environment
Treatment with effective antimicrobial
shortens period of infectivity
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Normal flora
Acquired from animals (cats and
others)
Rare outbreaks of pneumonia in
institutionalized populations
14 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Comments
Chlamydia
(Chlamydophila)
psittaci
(Psittacosis,
Ornithosis)
Cholera
(Vibrio cholerae
01, 0139)
Pneumonia,
undifferentiated
fever
Routine
Infected birds
Diarrhea
ADULT:
Routinei
PAEDIATRIC:
Contact
Feces
Direct and
2–3 days
indirect contact
(fecal/oral)
Duration of
shedding
Duration of
symptoms
Clostridium
difficile
Diarrhea,
pseudomembranous
colitis
Contact
Feces
Direct and
Variable
indirect contact
(fecal/oral)
Duration of
shedding
Duration of
symptoms
Clostridium
perfringens
Food poisoning
Routine
Foodborne
6–24 hours
Not person to
person
Gas gangrene,
abscesses,
myonecrosis
Pneumonia,
draining lesions
Routine
Variable
Not person to
person
Found in normal gut flora, soil;
infection related to devitalized tissue
Routine
1–4 weeks
Not person to
person
Acquired from spores in soil, dust in
endemic areas
3–6 days
Not person to
person
Coccidioidomycosis
(Coccidioides
immitis)
Colorado tick fever Fever
See Dengue Fever
(Arbovirus)
Congenital rubella
See Rubella
Coronavirus (CoV) Common cold
(other than SARSCoV)
For SARS CoV, see
Severe acute
respiratory
syndrome
Routine
Droplet and
contact
7–14 days
Tick-borne
Respiratory
secretions
Direct and
2–4 days
indirect contact
Possible large
droplet
Not person to
person
Until symptoms
cease
Acquired by inhalation of desiccated
droppings, secretions and dust of
infected birds
Duration of
symptoms
i
Consider contact precautions for
adults if stool cannot be contained or
for adults with poor hygiene who
contaminate their environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Bacterial spores persist in the
environment
Ensure scheduled environmental
cleaning
During outbreaks, special attention
should be paid to cleaning;
hypochlorite solutions may be
required if continued transmission
See Appendix VI. 3. Viral
Gastroenteritis
Dedicate patient care equipment
Relapses are common
May cohort if infected with same virus
Patient should not share room with
high-risk roommates
15 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Coxsackievirus
See Enteroviral
infections
Creutzfeldt-Jakob
disease (CJD)
Clinical
presentation
Chronic
encephalopathy
Precautions
Routinej
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Comments
j
Contaminated
neurosurgical
instruments;
tissue grafts
from infected
donors
PHAC guidelines for precautions for
surgery and other procedures may be
accessed at:
http://www.phac-aspc.gc.ca/noissinp/guide/pubs-eng.php
Notification of a suspected or
diagnosed case of CJD should be
made to the CJD surveillance system
(1-888-489-2999)
Crimean-Congo
fever
See Viral
hemorrhagic
fevers
Cryptococcosis
(Cryptococcus
neoformans)
Cryptosporidosis
(Cryptosporidium
parvum)
Pneumonia,
meningitis,
adenopathy
Diarrhea
Routine
Unknown
Not person to
person
ADULT:
Routinek
PAEDIATRIC:
Contact
Feces
Direct and
1–12 days
indirect contact
(fecal/oral)
From onset of
symptoms until
several weeks
after resolution
Cysticercosis
(Taenia solium
larvae)
T. solium larval
cysts in various
organs
Routine
Ova in feces
Direct contact
(fecal/oral)
Months to
years
While eggs
present in feces
Cytomegalovirus
Usually
asymptomatic;
congenital
infection,
retinitis,
mononucleosis,
pneumonia,
disseminated
infection in
immunocompromised
host
Routine
Saliva, genital
secretions,
urine, breast
milk,
transplanted
organs or stem
cells, blood
products
Directl
Sexual
transmission;
vertical mother
to child in
utero, at birth
or through
breast milk
Transfusion,
transplantation
Unknown
Virus is excreted
in urine, saliva,
genital
secretions,
breast milk for
many months;
may persist or be
episodic for life
Duration of
symptoms
k
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Transmissible only from humans with
T. solium adult tapeworm in
gastrointestinal tract (autoinfection
occurs)
No additional precautions for
pregnant HCWs
l
Close direct personal contact
necessary for transmission
Disease is often due to reactivation in
the patient rather than transmission of
infection
16 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Dengue
(arbovirus)
Dermatophytosis
See Tinea
Diphtheria
(Corynebacterium
diphtheriae)
Ebola
See Viral
hemorrhagic fever
Echinococcosis
(hydatidosis)
(E. granulosis,
E. multilocularis)
Echovirus
See Enterovirus
Enterobiasis
Oxyuriasis,
pinworm
(Enterobius
vermicularis)
Enterococcus
species
(vancomycinresistant only)
See Vancomycinresistant
enterococci
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Fever,
arthralgia, rash
Routine
Cutaneous
(characteristic
ulcerative
lesion)
Contact
Lesion
drainage
2–5 days
Direct or
indirect contact
If untreated,
2 weeks to
several months
Until 2
culturesm from
skin lesions
are negative
Pharyngeal
(adherent
greyish
membrane)
Droplet
Nasopharynge
al secretions
Large droplets, 2–5 days;
If untreated,
2 weeks to
several months
Until 2
culturesn from
both nose and
throat are
negative
Cysts in various
organisms
Routine
Perianal itching
Routine
Mosquitoborne
Ova in stool,
Direct, indirect
perianal region contact
3–14 days
Comments
Not person to
person
m
Cultures should be taken at least 24
hours apart and at least 24 hours
after cessation of antimicrobial
therapy.
Close contacts should be given
antimicrobial prophylaxis, as per most
recent NACI recommendations
available at:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
n
Cultures should be taken at least 24
hours apart and at least 24 hours
after cessation of antimicrobial
therapy
Close contacts should be given
antimicrobial prophylaxis
Months to
years
Not person to
person
Acquired from contact with infected
animals
Life cycle
requires 2–6
weeks
As long as gravid
females
discharge eggs
on perianal skin;
eggs remain
infective indoors
about 2 weeks
Direct transfer of infective eggs by
hand from anus to mouth of the same
or another person; indirectly through
clothing, bedding or other
contaminated articles
Close household contacts may need
treatment
17 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Enteroviral
infections
Echovirus,
Coxsackievirus A
Coxsackievirus B
Enterovirus
Poliovirus - See
poliomyelitis
Acute febrile
symptoms,
aseptic
meningitis,
encephalitis,
pharyngitis,
herpangina,
rash,
pleurodynia,
hand, foot and
mouth disease
Conjunctivitis
ADULT:
Routine
PAEDIATRIC:
Contact
Feces,
respiratory
secretions
Contact
Eye discharge
Infectious
mononucleosis
Routine
Diarrhea, food
poisoning,
hemolyticuremic
syndrome,
thrombotic
thrombocytopeni
c purpura
ADULT:
Routineo
PAEDIATRIC:
Contact
Epstein-Barr virus
Erythema
infectiosum
See Parvovirus
B19
Escherichia coli
(enteropathogenic
and
enterohemorrhagic
strains)
Fifth disease
See Parvovirus
German measles
See Rubella
Infective
material
Route of
transmission
Incubation
period
3–5 days
Direct and
indirect contact
(fecal/oral)
Direct and
1–3 days
indirect contact
4–6 weeks
Saliva,
Direct
transplanted
oropharyngeal
organs or stem route via
cells
saliva;
transplantation
Feces
Period of
communicability
1–8 days
Direct and
indirect contact
(fecal/oral)
Foodborne
Duration of
precautions
Duration of
symptoms
If poliovirus,
see
Poliomyelitis
Comments
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Duration of
symptoms
Prolonged;
pharyngeal
excretion may be
intermittent or
persistent for
years
Duration of
shedding
Duration of
symptoms
If hemolyticuremic
syndrome:
until 2 stools
negative for
E. coli
O157:H7 or 10
days from
onset of
diarrhea
o
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
18 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Giardia
(Giardia lamblia)
Clinical
presentation
Diarrhea
Precautions
ADULT:
Routinep
PAEDIATRIC:
Contact
Infective
material
Feces
Route of
transmission
Entire period of
infection; often
months
Sexual
transmission
Unknown;
probably for the
duration of open
lesions on the
skin or mucous
membranes
Most infectious in
the week prior to
onset of
symptoms and
during the
symptoms until
treated
Routine
Haemophilus
influenzae type B
(invasive
infections)
Pneumonia,
epiglottitis,
meningitis,
bacteremia,
septic arthritis,
cellulitis,
osteomyelitis in
a child
ADULT:
Routine
PAEDIATRIC:
Droplet
Respiratory
secretions
Fever,
pneumonia
Routine
Rodent excreta Presumed
aerosol
transmission
from rodent
excreta
Helicobacter pylori Gastritis,
duodenal ulcer
disease
Routine
Period of
communicability
3–25 days
Direct and
indirect contact
(fecal/oral)
Granuloma
Painless genital
inguinale
ulcers, inguinal
(Donovanosis)
ulcers, nodules
(Calymmatobacteri
um granulomatis)
Hand foot and
mouth disease
See Enteroviral
infections
Hansen’s disease
See Leprosy
Hantavius
(Hantavirus
pulmonary
syndrome)
Incubation
period
Unknown;
probably
between 1 and
16 weeks
Large droplets, Variable
direct contact
Probable
ingestion of
organisms;
presumed
fecal/oral/oral/o
ral
A few days to 6 Not well defined,
person to person
weeks
is rare (person to
person
documented for
South American
strains)
5–10 days
Unknown
Duration of
precautions
Comments
Duration of
symptoms
p
Until 24 hours
of appropriate
antimicrobial
therapy has
been received
Close contacts <48 months old and
who are not immune may need
chemoprophylaxis
Household contacts of such children
should also receive prophylaxis
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Infection acquired from rodents
19 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Hepatitis,
anicteric acute
febrile
symptoms
ADULT:
Routineq
PAEDIATRIC:
Contact
Feces
Hepatitis B, C, D, G Hepatitis, often
viruses
asymptomatic;
cirrhosis,
hepatic cancer
Routine
Herpes simplex
virus
ADULT:
Routine
PEDS:
Contact
Contact
Hepatitis A, E
Encephalitis
Neonatal
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Comments
A: 28–30 days
Direct and
indirect contact E: 26–42 days
(fecal/oral)
A: 2 weeks
before to 1 week
after onset of
jaundice
Shedding is
prolonged in the
newborn
E: not known; at
least 2 weeks
before onset of
symptoms
1 week after
onset of
jaundice;
duration of
hospitalization
if newborn
Blood, genital
secretions, and
certain other
body fluids
Mucosal or
percutaneous
exposure to
infective body
fluids
Sexual
transmission;
Vertical mother
to child
B: 2–3 months
C: 2 weeks–6
months
D: 2–8 weeks
B: all persons
who are hepatitis
B surfaceantigenpositive are
infectious
C: indefinite
D: indefinite
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Postexposure prophylaxis indicated
for non-immune household contacts
with significant exposure to
hepatitis A if within 2 weeks of
exposure
Refer to Canadian Immunization
Guide for specific information:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
Outbreaks of HAV in HCWs have
been associated with eating and
drinking in patient care areas
Refer to Canadian Immunization
Guide 7th Ed., 2006 for specific
information, available at:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
Contact OH or delegate if HCW has
percutaneous, non-intact skin or
mucous membrane exposure.
Refer to CDC dialysis
recommendations available at:
http://www.cdc.gov/mmwr/preview/m
mwrhtml/rr5005a1.htm
Skin or
mucosal
lesions;
possibly all
body
secretions and
excretions
Direct contact
Birth to 6
weeks of age
Duration of
symptoms
Contact precautions are also
indicated for infants delivered vaginally
(or by C-section if membranes have
been ruptured more than 4–6 hours) to
women with active genital HSV
infections, until neonatal HSV infection
has been ruled out
q
20 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Mucocutaneous: Contact
disseminated or
primary and
extensive
(gingivostomatiti
s, eczema
herpeticum)
Recurrent
Routine
Herpes zoster
See Varicella
zoster
Histoplasmosis
(Histoplasma
capsulatum)
Hookworm
(Necator
americanus,
Ancyclostoma
duodenale)
Human
herpesvirus 6
(HHV-6)
See Roseola
Human immunodeficiency virus
(HIV)
Infective
material
Skin or
mucosal
lesions
Sexual
transmission
Mother to child
at birth
Pneumonia,
Routine
lymphadenopath
y, fever
Routine
Usually
asymptomatic
Asymptomatic;
multiple clinical
presentations
Routine
Blood, genital
secretions,
breast milk and
certain other
body fluids
Human metapneumovirus
Respiratory tract Droplet and
contact
infection
Respiratory
secretions
Human T-cell
leukemia virus,
human Tlymphotrophic
virus (HTLV-I,
HTLV-II)
Usually
asymptomatic,
tropical spastic,
paraperisis,
lymphoma
Breast milk,
blood and
certain other
body fluids
Infectious
mononucleosis
See Epstein-Barr
virus
Routine
Route of
transmission
Direct contact
Incubation
period
Period of
communicability
Duration of
precautions
Comments
2 days–2
weeks
While lesions
present
3–17 days
Not person to
person
Acquired from spores in soil
Percutaneous;
fecal/oral
Few weeks to
many months
Not person to
person
Larvae must hatch in soil to become
infectious
Mucosal or
percutaneous
exposure to
infective body
fluids
Sexual
transmission,
vertical mother
to child
Large droplets
Direct and
indirect contact
Vertical mother
to child;
mucosal or
percutaneous
exposure to
infective body
fluids
Weeks to
years
From onset of
infection
Contact OH or delegate immediately
if HCW has percutaneous, non-intact
skin or mucous membrane exposure
3–5 days
Weeks to
years
Until lesions
are dry and
crusted
Duration of
symptoms
Indefinite
May cohort if infected with same virus
Patient should not share room with
high-risk roommates
21 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Influenza
Seasonal
Respiratory tract Droplet and
contact
infection
Respiratory
secretions
Large droplets, 1–3 days
direct and
indirect contact
Generally 3–7
Duration of
days from clinical symptoms
onset
Prolonged
shedding may
occur in immunocompromised
individuals.
Pandemic
Novel influenza
viruses
Respiratory tract Pandemic
infection
influenza
precautionsr
As seasonal
As seasonal
Unknown;
possibly 1–7
days
Unknown,
possibly up to 7
days
Avian
Respiratory tract Droplet and
infection,
contact
conjunctivitis
Excreta of sick
birds, possibly
human
respiratory
tract secretions
2–10 days;
Not person to
person
Lassa fever
See Viral
hemorrhagic fever
Legionella
(Legionella spp.)
Legionnaires’
disease
Pneumonia,
Routine
Legionnaires’
disease, Pontiac
fever
Duration of
symptoms
Comments
If private room is unavailable,
consider cohorting patients during
outbreaks
Patient should not share room with
high-risk roommates
Consider antiviral for exposed
roommates
See Guidance: IP&C Measures for
HCWs in Acute Care and Long-term
Care Settings at:
http://www.phac-aspc.gc.ca/noissinp/guide/pubs-eng.php
For further information for all types of
influenza see:
http://www.phacaspc.gc.ca/influenza/index-eng.php
See Canadian Pandemic Plan Annex
F, Infection Prevention and Control
and Occupational Health and Hygiene
guidelines during Pandemic Influenza
in Existing and Temporary Healthcare
Settings, available at:
http://www.phacaspc.gc.ca/influenza/index-eng.php
Refer to PHAC website for specific
guidance documents. Available at
http://www.phac-aspc.gc.ca/noissinp/guide/pubs-eng.php
For current information on Avian
influenza, see
Human Health Issues Related to
Domestic Avian Influenza in Canada,
available at"
http://www.phacaspc.gc.ca/influenza/index-eng.php
http://www.phacaspc.gc.ca/publicat/daio-enia/9eng.php
Acquired from contaminated water
sources (inhalation not ingestion)
22 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Leprosy
(Hansen’s disease)
(Mycobacterium
leprae)
Chronic disease
of skin, nerves,
nasopharyngeal
mucosa
Routine
Leptospirosis
(Leptospira sp.)
Fever, jaundice,
aseptic
meningitis
Routine
Infective
material
Nasal
secretions,
skin lesions
Route of
transmission
Direct contact
Incubation
period
Lice (pediculosis)
Scalp or body
Head
itch, itchy rash
Body
Pubic (crab)
(Pediculus capitas,
Pediculus
corporis, Pediculus
humanus, Phthirus
pubis)
Routine, plus
gloves for
direct patient
contact only
Listeriosis
(Listeria
monocytogenes)
Fever,
meningitis
Congenital or
neonatal
infection
Routine
Foodborne;
Vertical mother
to child in utero
or at birth
mean 21 days;
3–70 days
following a
single
exposure to an
implicated food
product
Lyme disease
(Borrelia
burgdorferi)
Fever, arthritis,
rash, meningitis
Routine
Tickborne
Lymphocytic
choriomeningitis
virus
Lymphogranuloma
venereum
(C. trachomatis
serovars L1, L2,
L3)
Aseptic
meningitis
Routine
To initial rash:
3–32 days;
mean 7–10
days
6–21 days
Genital ulcers,
inguinal
adenopathy
Routine
Head and body 6–10 days
lice: direct and
indirect contact
Pubic lice:
usually sexual
contact
Urine of
rodents
Sexually
transmitted
Duration of
precautions
9 months to 20
years
2–30 days
Louse
Period of
communicability
Range of 3–30
days for a
primary lesion
Direct person to
person
transmission is
rare
Until effective
treatment to kill
lice and ova
Comments
Transmitted between persons only
with very prolonged extensive close
personal contact
Household contacts should be
assessed and may be given
prophylaxis
Acquired from contact with animals
Until 24 hours
after
application of
appropriate
pediculicide;
applied as
directed
Apply pediculicides as directed on
label. If live lice found after therapy,
repeat
Head lice: wash headgear, combs,
pillowcases, towels with hot water or
dry clean or seal in plastic bag and
store for 10 days.
Body lice: as above, for all exposed
clothing and bedding
Pregnant women and
immunocompromised persons should
avoid cheese made with
unpasteurized milk, cold cuts and
uncooked meat products, including
hot dogs
Listeria grows well at low
temperatures and is able to multiply in
refrigerated foods that are
contaminated
Nosocomial outbreaks reported in
newborn nurseries due to
contaminated equipment or materials
Not person to
person
Not person to
person
Acquired from contact with rodents
23 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Malaria
(Plasmodium sp.)
Marburg virus
See Viral
haemorrhagic
fever
Measles
(Rubeola)
Melioidosis
(Pseudomonas
pseudomallei)
Meningococcus
(Neisserria
meningitidis)
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Fever
Routine
Blood
Mosquitoborne; rarely
transplacental
from mother to
fetus; blood
transfusion
Variable; 9–14
days for P.
falciparum
Not normally
person to person
Fever, cough,
coryza,
conjunctivitis,
maculopapular
skin rash
Airborne
Respiratory
secretions
Airborne
7–18 days to
onset of fever;
rarely as long
as 21 days
5 days before
onset of rash (1–
2 days before
onset of initial
symptoms) until
4 days after
onset of rash
(longer in
immunocompromised
patients)
4 days after
start of rash;
duration of
symptoms in
immunocompromised
patients
Susceptible
contact
Airborne
Respiratory
secretions
Airborne
Potentially
communicable
during last
2 days of
incubation period
From 5 days
after first
exposure
through 21
days after last
exposure
regardless of
postexposure
prophylaxis
Pneumonia,
fever
Routine
Contaminated
soil
Rash
Droplet
(petechial/purpu
ric) with fever
Meningococcem
ia meningitis,
pneumonia
Respiratory
secretions
Can be transmitted via blood
transfusion
Variable
Large droplet,
direct contact
Usually 2–10
days
Comments
Until 24 hours
of effective
antimicrobial
therapy has
been received
Only immune HCWs, caretakers and
visitors should enter the room
Respirator needed for non-immune
persons who must enter
Precautions should be taken with
neonates born to mothers with
measles infection at delivery
Immunoprophylaxis is indicated for
susceptible contacts
Refer to Canadian Immunization
Guide 7th Ed., 2006 for specific
information available at:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
Only immune HCWs, caretakers and
visitors should enter the room
Respirator needed for non-immune
persons who must enter
Precautions should be taken with
neonates born to mothers with
measles infection at delivery
Immunoprophylaxis is indicated for
susceptible contacts
Organism in soil in Southeast Asia
Person-to-person has not been
proven
Close contacts may need
chemopropylaxis as per most recent
NACI recommendations available at:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php and http://www.phacaspc.gc.ca/publicat/cig-gci/p04-menieng.php
24 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Methicillinresistant
Staphylococcus
aureus (MRSA)
See ARO
Molluscum
contagiosum
Monkeypox
Mucormycosis
(phycomycosis;
zygomycosis)
(Mucor,
Zygomycetes)
Mumps
Mycobacterium
non-TB (atypical)
Clinical
presentation
Precautions
Umbilicated
papules
Resembles
smallpox;
lymphadenopath
y is a more
predominant
feature
Routine
Skin, wound,
rhinocerebral,
pulmonary,
gastrointestinal,
disseminated
infectiont
Swelling of
salivary glands,
orchitis,
meningitis
Routine
Lymphadenitis;
pneumonia;
disseminated
disease in
immunocompromised
host
Routine
Contact,s
droplet and
airborne
Droplet
Infective
material
Contents of
papules
Lesions and
respiratory
secretions
Route of
transmission
Direct contact
Incubation
period
2 weeks to 6
months
Contact with
infected
animals;
possible
airborne
transmission
from animals to
humans
Fungal spores Inhalation or
Unknown
in dust and soil ingestion of
fungal spores
Saliva
Large droplets, Usually 16–18
direct contact
days; range
14–25 days
Unknown
Period of
communicability
Duration of
precautions
Unknown
s
Contact: until
all lesions
crusted
Comments
Close direct personal contact needed
for transmission
Transmission in hospital settings is
unlikely. See
http://www.cdc.gov/ncidod/monkeypo
x for current recommendations
Not person to
person
Unknown
Acquired from spores in dust, soil
t
Infections in immunocompromised
patients
Viral excretion
highest 2 days
before to 5 days
after onset or
parotitis
Until 5 days
after onset of
parotitis
Droplet precautions for exposed
susceptible patients/HCWs should
begin 10 days after first contact and
continue through 26 days after last
exposure
For outbreaks, see:
http://www.phacaspc.gc.ca/publicat/ccdrrmtc/10pdf/36s1-eng.pdf
Acquired from soil, water, animal,
reservoirs
Not person to
person
25 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Mycobacterium
tuberculosis
including M.
tuberculosis
subsp. canetti, M.
bovis, M. bovis
BCG, M.africanum,
M. caprae, M.
microti and M.
pinnipedii
Clinical
presentation
Confirmed or
suspected
respiratory
(including
pleural,
laryngeal)
Precautions
Airborneu
Infective
material
Respiratory
secretions
Route of
transmission
Airborne
Incubation
period
Weeks to
years
Period of
communicability
Duration of
precautions
Comments
While organisms
is viable in
sputum
Until deemed
no longer
infectious
If confirmed,
until patient
has received 2
weeks of
effective
therapy, and is
improving
clinically, and
has 3
consecutive
sputum
smears
negative for
acid fast
bacilli,
collected 8–24
hours apart
with at least 1
early morning
specimen
If multi-drugresistant TB,
until sputum
culture
negative
TB in young children is rarely
transmissible; due to lack of cavitary
disease and weak cough
Assess visiting family members for
cough
Canadian Tuberculosis Standards,
http://www.phac-aspc.gc.ca/tbpclatb/pubs/tbstand07-eng.php uAGMP,
see strategies to reduce aerosol
generation Part B, Section IV,
subsection iii, 1b
Nonpulmonary: Routine
meningitis, bone
or joint infection
with no drainage
Mycoplasma
pneumoniae
Nonpulmonary:
skin or soft
tissue draining
lesions
PPD skin test
positive with no
evidence of
current
pulmonary
disease
Pneumonia
Routine,
Airbornev
Most patients with nonpulmonary
disease alone are noncontagious; it is
important to assess for concurrent
pulmonary TB
Aerosolized
wound
drainage
Routine
Droplet
While viable
micro
organisms are
in drainage
Non
communicable
Respiratory
secretions
Large droplets
1–4 weeks
Unknown
Duration of
symptoms
v
Airborne precautions if procedures
that may aerosolize drainage are
being performed
26 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Neisseria
gonorrhoeae
Neisseria
meningitidis
See
Meningococcus
Nocardiosis
(Nocardia sp.)
Noroviruses
(Norwalk-like
agents,
caliciviruses)
Clinical
presentation
Urethritis,
cervicitis, pelvic
inflammatory
disease,
arthritis,
ophthalmia
neonatorum,
conjunctivitis
Precautions
Routine
Fever,
Routine
pulmonary or
CNS infection or
disseminated
disease
Nausea,
Contact
vomiting,
diarrhea
Orf
Routine
Skin lesions
(poxvirus)
Parainfluenza virus Respiratory tract Droplet and
contact
infection
Parvovirus B-19
Human parvovirus
Pediculosis
See lice
Erythema
infectiosum (fifth
disease),
aplastic or
erythrocytic
crisis
Infective
material
Route of
transmission
Sexual
transmission
Mother to child
at birth
Rarely:
direct/indirect
contact
Feces
Respiratory
secretions
Routine: fifth Respiratory
disease
secretions
Droplet:
aplastic crisis
or chronic
infection in
immunocompromised
patient
Incubation
period
Period of
communicability
2–7 days
May extend for
months if
untreated
Unknown
Not person to
person
Duration of
precautions
Acquired from organisms in dust, soil
Direct and
Usually 24–48 Duration of viral
48 hours after
indirect contact hours; range of shedding; usual
resolution of
(fecal/oral)
10–50 hours
illness
48 hours after
diarrhea resolves
Generally 3–6
days
Large droplets, 2–6 days
direct and
indirect contact
Large droplets, 4–21 days to
direct contact
onset of rash
Vertical mother
to fetus
Not person to
person
1-3 weeks
Fifth disease: no
longer infectious
by the time the
rash appears
Aplastic crisis: up
to 1 week after
onset of crisis
Immunocompromised
with chronic
infection: months
to years
Comments
Duration of
symptoms
Aplastic or
erythrocytic
crisis: 7 days
Chronic
infection in
immunocompromised
patient:
duration of
hospitalization
During outbreaks, special attention
should be made to cleaning;
hypchlorite solutions may be required
if continued transmission
See Appendix VI 3. Viral
Gastroenteritis
Acquired from infected animals.
May cohort if infected with same virus
Patient should not share room with
high-risk roommates
27 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Pertussis
(Bordetella
pertussis,
Bordetella
parapertussis)
Pinworms
See Enterobius
Plague
(Yersinia pestis)
Pneumocystis
jiroveci (carinii)
Poliomyelitis
Infantile paralysis
Prion disease
See CreutzfeldtJakob disease
Psittacosis
See Chlamydia
psittace
Q Fever
(Coxiella burnetii)
Clinical
presentation
Precautions
Droplet
Whooping
cough, nonspecific
respiratory tract
infection in
infants,
adolescents and
adults
Infective
material
Respiratory
secretions
Route of
transmission
Large droplets
Incubation
period
Period of
communicability
Average 9–10 To 3 weeks after
days; range 6– onset of
20 days
paroxysms if not
treated
Bubonic
(lymphadenitis)
Pneumonic
(cough, fever,
hemoptysis)
Routine
Pneumonia in
immunocompromised
host
Fever, aseptic
meningitis,
flaccid paralysis
Routine
Contact
Feces,
respiratory
secretions
Direct and
3–35 days
indirect contact
Virus in the
throat for
approximately
1 week and in
feces for 3–6
weeks
Pneumonia,
fever
Routine
Infected
animals, milk
Direct contact
with infected
animals; raw
milk
Airborne from
aerosolized
contaminated
dust
Not person to
person
Droplet
Rodents and
their fleas
Respiratory
secretions
Duration of
precautions
Comments
To 3 weeks
after onset of
paroxysms if
not treated; or
until 5 days of
appropriate
antimicrobial
therapy
received
Close contacts (household and
HCWs) may need chemoprophylaxis
and/or immunization
If HCWs immunization not up to date,
refer to OH and/or delegate
Refer to Canadian Immunization
Guide 7th Ed., 2006 for specific
information available at:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
Until 48 hours
of appropriate
antimicrobial
therapy
received
Close contacts and exposed HCWs
may need prophylaxis
1–7 days
Large droplets
1–4 days
Unknown
Unknown
14–39 days
Until 48 hours of
appropriate
antimicrobial
therapy received
Ensure roommates are not
immunocompromised
Until 6 weeks
from onset of
symptoms or
until feces viral
culture
negative
Most infectious during the days
before and after onset of symptoms
Close contacts who are not immune
should receive immunoprophylaxis
Acquired from contact with infected
animals or from ingestion of raw milk
28 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Mucosal or
percutaneous
exposure to
saliva; corneal,
tissue and
organ
transplantation
Rodent bite,
ingestion of
contaminated
milk
Usually 3–8
weeks, rarely
as short as
9 days or as
long as 7 years
Person-to-person
transmission is
theoretically
possible, but rare
and not well
documented
Acquired from contact with infected
animals
Postexposure prophylaxis is
recommended for percutaneous or
mucosal exposure to saliva of rabid
animal or patient
A. moniliformis
days 3–10
days, rarely
longer;
S. minus 1–3
weeks
Not person-toperson
A. moniliformis: rats and other
animals, contaminated milk
S. minus: rats, mice only
Vector-borne
Not person to
person
Spread by ticks or lice
Shortly before
and for the
duration of active
disease
Until symptoms
cease
Rabies
Routine
Acute
encephalomyeliti
s
Saliva
Rat bite fever
Actinobacillus
(formerly
Streptobacillus
moniliformis)
Spirillum minus
Relapsing fever
(Borellia
recurrentis, other
Borellia species)
Respiratory
syncytial virus
(RSV)
Fever, arthralgia Routine
Saliva of
infected
rodents;
contaminated
milk
Respiratory tract Droplet and
contact
infection
Respiratory
secretions
Large droplets, 2-8 days
direct and
indirect contact
Rhinovirus
Respiratory tract Contact and
droplet
infection,
common cold
Respiratory
secretions
2–3 days
Rickettsialpox
(Rickettsia akari)
Ringworm
See Tinea
Rocky Mountain
spotted fever
(Rickettsia
rickettsia)
Fever, rash
Routine
Direct and
indirect
contact,
possibly large
droplets
Mite-borne
9–14 days
Not person to
person
Fever, petechial
rash,
encephalitis
Routine
Tick-borne
3–14 days
Roseola infantum
(HHV-6)
Rotavirus
Rash, fever
Routine
Saliva
Direct contact
10 days
Not transmitted
from person to
person, except
rarely through
transfusion
Unknown
Diarrhea
Contact
Feces
1–3 days
Direct and
indirect contact
(fecal/oral)
Roundworm
See Ascariasis
Recurrent fevers Routine
Duration of viral
shedding
Duration of
precautions
Comments
Duration of
symptoms
May cohort if infected with same virus
Patient should not share room with
high-risk roommates
Duration of
symptoms
May cohort if infected with same virus
Patient should not share room with
high-risk roommates
Transmitted by mouse mites
Close direct personnel contact
needed for transmission
Duration of
symptoms
29 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Rubella, acquired
Fever,
maculopapular
rash
Rubella, congenital Congenital
rubella
syndrome
Rubeola
See Measles
Salmonella
(including
Salmonella Typhi)
Diarrhea, enteric
fever, typhoid
fever, food
poisoning
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Droplet
Respiratory
secretions
Large droplets, 14–21 days
direct contact
For about 1 week Until 7 days
before and after after onset of
onset of rash.
rash
Droplet and
contact
Respiratory
secretions,
urine
Direct and
indirect
contact; large
droplets
Prolonged
shedding in
respiratory tract
and urine; can be
up to one year
Until one year
of age, unless
nasopharynge
al and urine
cultures done
after 3 months
of age are
negative
ADULT:
Routinew
PAEDIATRIC:
Contact
Feces
Direct and
6–72 hours
indirect contact
(fecal/oral);
foodborne
Variable
Duration of
symptoms
Comments
Only immune HCWs, caretakers and
visitors should enter the room
Pregnant HCWs should not care for
rubella patients, regardless of their
immune status
If it is essential for a non-immune
person to enter the room, facial
protection should be worn
Droplet precautions should be
maintained for exposed susceptible
patients from 7 days after first contact
through to 21 days after last contact
Administer vaccine to exposed
susceptible non-pregnant persons
within 3 days of exposure
Refer to Canadian Immunization
Guide 7th Ed., 2006 for specific
information available at:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
Exclude susceptible HCWs from duty
from day 7 after first exposure to
day 21 after last exposure, regardless
of postexposure vaccination
As per Rubella, acquired
w
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
30 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Scabies
Itchy skin rash
(Sarcoptes scabiei)
Scarlet fever
See Group A
Streptococcus
Schistosomiasis
(bilharziasis)
(Schistosoma sp.)
Shigella
Severe acute
respiratory
syndrome (SARS
coronavirus)
Shingles
See Herpes zoster
Diarrhea, fever,
itchy rash
Hepatosplenomegaly,
hematuria
Diarrhea
Precautions
Contact
Infective
material
Mite
Route of
transmission
Incubation
period
Direct and
Without
indirect contact previous
exposure, 2–6
weeks; 1–4
days after reexposure
Routine
ADULT:
Routinex
PAEDIATRIC:
Contact
Contact and
Malaise,
myalgia,
droplet y
headache, fever, AGMP
respiratory
symptoms
(cough,
increasing
shortness of
breath),
pneumonia,
acute respiratory
distress
syndrome
Period of
communicability
Duration of
precautions
Comments
Until mites and
eggs are
destroyed by
treatment,
usually after 1 or
occasionally 2
courses of
treatment, 1
week apart
Until 24 hours
after initiation
of appropriate
therapy
Apply scabicide as directed on label.
Wash clothes and bedding in hot
water, dry clean or seal in a plastic
bag, and store for 1 week
Household contacts should be treated
Not person to
person
Contact with larvae in contaminated
water.
Feces
Direct and
1–3 days
indirect contact
(fecal/oral)
Usually 4 weeks
if not treated
Duration of
symptoms
Respiratory
secretions,
stool
Droplet, direct
and indirect
contact
Aerosols
during AGMP
Not yet
determined;
suggested to be
less than 21 days
10 days
following
resolution of
fever if
respiratory
symptoms
have also
resolved
3–10 days
x
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Treatment with effective antimicrobial
shortens period of infectivity
y
AGMP, see strategies to reduce
aerosol generation, see Part B,
Section IV, subsection iii, 1b
May cohort if infected with same virus
Patient should not share room with
high-risk roommates
31 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Smallpox
(variola virus)
Generalized
vaccinia, eczema
vaccinatum
See Vaccinia for
management of
vaccinated
persons
Droplet,
Fever,
vesicular/pustula contact and
airborne
r in appropriate
epidemiologic
context
Sporotrichosis
(Sporothrix
schenckii)
Staphylococcus
aureus
(if methicillinresistant, see also
ARO)
Skin lesions,
disseminated
Routine
Skin (furuncles,
impetigo) wound
or burn infection;
abscess;
scalded skin
syndrome,
osteomyelitis
Endometritis
Food poisoning
Pneumonia
MINOR:
Routine
MAJOR:
Contactz
Toxic shock
syndrome
Routine
Pneumonia,
meningitis and
other
Routine
Streptobacillus
moniliformis
disease
See Rat-bite fever
Streptococcus
pneumoniae
Routine
Routine
ADULT:
Routine
PAEDIATRIC:
Droplet
Infective
material
Skin lesion
exudate,
oropharyngeal
secretions
Drainage, pus
Respiratory
secretions
Route of
transmission
Incubation
period
Airborne, direct 7–10 days
and Indirect
contact
Period of
communicability
Duration of
precautions
Onset of mucosal
lesions, until all
skin lesions have
crusted
Until all scabs
have crusted
and separated
(3–4 weeks)
Variable
Rare person to
person
Variable
Direct and
indirect contact
As long as
organism is in
the exudates or
drainage
Foodborne
Large droplets, Variable
direct contact
Variable
Comments
Immunization of HCWs was stopped
in 1977
Refer to Canadian Immunization
Guide 7th Ed., 2006 for information
regarding vaccine,
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
NACI Statement on Smallpox
Vaccination, http://www.phacaspc.gc.ca/publicat/ccdrrmtc/02vol28/28sup/acs1.html
Care preferably should be provided
by immune HCWs; non-vaccinated
HCWs should not provide care if
immune HCWs are available
Respirator for all regardless of
vaccination status
Acquired from spores in soil, on
vegetation
Until drainage
resolved or
contained by
dressings
z
MAJOR: drainage not contained by
dressings
Until 24 hours
of appropriate
antimicrobial
therapy
received
Normal flora
32 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Streptococcus,
Group A
(Streptococcus
pyogenes)
Streptococcus,
Group B
(Streptococcus
agalactiae)
Stronglyoides
(Stronglyoides
stercoralis)
Syphilis
(Treponema
pallidum)
Clinical
presentation
Skin (e.g.,
erysipelas,
impetigo),
wound or burn
infection
Scarlet fever,
pharyngitis, in
children
Group A
Streptococcus
endometritis
(puerperal fever)
Group A
Streptococcus
toxic shock,
invasive disease
(including
necrotizing
fasciitis,
myositis,
meningitis,
pneumonia)
Group B
Streptococcus
newborn sepsis,
pneumonia,
meningitis
Usually
asymptomatic
Genital, skin or
mucosal lesions,
disseminated
disease,
neurological or
cardiac disease;
latent infection
Precautions
Infective
material
Route of
transmission
Incubation
period
MINOR:
Routine
MAJOR:
Contactaa
Drainage, pus
Direct and
1–3 days,
indirect contact rarely longer
ADULT:
Routine
PAEDIATRIC:
Contact and
droplet
Routine
Respiratory
secretions
Large droplets, 2–5 days
Droplet and
contact
Respiratory
secretions,
wound
drainage
Large droplets,
direct or
indirect contact
Routine
Mother to child
at birth
Routine
Larvae in feces
Routine
Gloves for
direct contact
with skin
lesions
Genital
secretions,
lesion
exudates
Direct contact
with infectious
exudates or
lesions
Sexual
transmission,
Intrauterine or
intrapartum
from mother to
child
Period of
communicability
Duration of
precautions
As long as
organism
is in the exudates
or drainage
Until 24 hours
of appropriate
antimicrobial
therapy
received
10–21 days if not Until 24 hours
treated
of appropriate
antimicrobial
therapy
received
Until 24 hours
of appropriate
antimicrobial
therapy
received
Early onset: 1–
7 days of age;
late onset: 7
days to 3
months of age
Unknown
Rarely
transmitted
person to person
10–90 days;
When moist
usually 3
muco-cutaneous
weeks
lesions of
primary and
secondary
syphilis are
present
Comments
aa
MAJOR: drainage not contained by
dressings
Chemoprophylaxis may be indicated
for close contacts of patients with
invasive disease or toxic shock
syndrome
For further information see:
http://www.phacaspc.gc.ca/publicat/ccdrrmtc/06pdf/32s2_e.pdf
Normal flora
Infective larvae in soil
May cause disseminated disease in
immuno-compromised patient
33 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Tapeworm
(Taenia saginata,
Taenia solium,
Diphyllobothrium
latum)
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Usually
asymptomatic
Routine
Larvae in food
Foodborne
Variable
Not transmissible
person to person
Tapeworm
Usually
(Hymenolepsis
asymptomatic
nana)
Tetanus
Tetanus
(Clostridium tetani)
Routine
Ova in rodent
or human
feces
Direct contact
(fecal/oral)
2–4 weeks
While ova in
feces
Tinea
(Dermatophytosis)
(Trichophyton sp.,
Microsporom sp.,
Epidermophyton
sp., Malassezia
furor)
Toxic shock
syndrome
See S. aureus,
Group A
Streptococcus
Toxocariasis
(Toxocara canis,
Toxocara cati)
Toxoplasmosis
(Toxoplasma
gondii)
Routine
Trachoma
See Chlamydia
trachomatis
Transmissible
spongiform
encephalopathy
See CreutzfeldJacob disease
Ringworm (skin,
beard, scalp,
groin, perineal
region); athletes
foot; pityriasis
versicolor
Routine
Fever, wheeze, Routine
rash,
eosinophilia
Asymptomatic,
Routine
fever,
lymphadenopath
y; retinitis,
encephalitis in
immunocompromised
host; congenital
infection
1 day to
Not person to
several months person
Organism in
skin or hair
Ova in dog/cat
feces
Direct skin-toskin contact
Variable; 4–14
days
While lesion
present
Unknown
Not person to
person
Intrauterine
5–23 days
transmission
from mother to
foetus;
transplantation
of stem cells or
organs
Duration of
precautions
Comments
Consumption of larvae in raw or
undercooked beef or pork or raw fish;
larvae develop into adult tapeworms
in gastrointestinal tract
Individuals with T. solium adult
tapeworms may transmit cysticercosis
to others
Acquired from spores in soil which
germinate in wounds, devitalized
tissue
May be acquired from animals,
shared combs, brushes, clothing,
hats, sheets, shower stalls
Acquired from contact with dogs, cats
Acquired by contact with infected
felines or soil contaminated by
felines, consumption of raw meat,
contaminated raw vegetables or
contaminated water
34 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Trench fever
(Bartonella
quintana)
Trichinosis
(Trichinella
spiralis)
Trichomoniasis
(Trichomonas
vaginalis)
Trichuriasis
(whipworm)
(Trichuris
trichiura)
Tuberculosis (TB)
See
Mycobacterium
tuberculosis
Tularemia
(Francisella
tularensis)
Typhoid/
paratyphoid fever
See Salmonella
Typhus fever
(Rickettsia typhi)
Endemic fleaborne typhus
Rickettsia
prowazekii
Epidemic louseborne fever
Clinical
presentation
Precautions
Relapsing
fevers, rash
Routine
Fever, rash,
diarrhea
Routine
Vaginitis
Routine
Abdominal pain,
diarrhea
Routine
Infective
material
Feces of
human body
lice
Infected meat
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Comments
Louse-borne
7–30 days
Food-borne
5–45 days
Sexually
transmitted
4–20 days
Duration of
infection
Unknown
Not person to
person
Ova must hatch in soil to be infective
1–14 days
Not person to
person
Acquired from contact with infected
animals
F. tularensis is hazardous to
laboratory workers; notify laboratory if
diagnosis is suspected
From 1–2
weeks,
commonly 12
days
1–2 weeks
Not transmitted
person to person
Fever,
Routine
lymphadenopath
y, pneumonia
Fever, rash
Routine
Rat fleas
Flea borne
Fever, rash
Routine
Human body
louse
Louse borne
Not person to
person in the
absence of lice
Not person to
person
Acquired from consumption of
infected meat
Person-to-person through close
personal contact, not transmitted in
absence of louse
35 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Comments
Vaccinia
Range of
adverse
reactions to the
smallpox
vaccine (e.g.,
eczema
vaccinatum,
generalized or
progressive
vaccinia, other)
Contact
Skin exudates
3–5 days
Direct and
indirect contact
Until all skin
lesions resolved
and scabs
separated
Until all skin
lesions dry
and crusted
and scabs
separated
Vaccinia may be spread by touching
a vaccination site before it has healed
or by touching bandages or clothing
that may have been contaminated
with live virus from the smallpox
vaccination site.
Immunization of HCWs was stopped
in 1977.
Refer to Canadian Immunization
Guide 7th Ed., 2006 for information
regarding vaccine,
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
NACI Statement on Smallpox
Vaccination, http://www.phacaspc.gc.ca/publicat/ccdrrmtc/02vol28/28sup/acs1.html
Vancomycinresistant
enterococci (VRE)
Infection or
colonization of
any body site
Contact
Direct and
Variable
indirect contact
Duration of
colonization
As directed by
ICP
Vancomycinresistant S. aureus
(VRSA)
Theoretical; to
date, not reported
Varicella zoster
virus
Varicella
(chickenpox)
Infection or
colonization of
any body site
Contact
Infected or
colonized
secretions,
excretions
Infected or
colonized
secretions,
excretions
Direct and
Variable
indirect contact
Duration of
colonization
As directed by
ICP
Enterococci persist in the
environment; pay special attention to
cleaning
See Appendix VI, 2. ARO
Local public health authorities should
be notified immediately
See Appendix VI, 2. ARO.
Fever with
vesicular rash
Airborne and
contact
Skin lesion
drainage,
respiratory
secretions
Airborne, direct 10–21 days
and indirect
contact
1–2 days before
rash and until
skin lesions have
crusted
May be
prolonged in
immunocompromised
patients
Until all
lesions have
crusted and
dried
HCWs, roommates and caregivers
should be immune to chickenpox
No additional precautions for
pregnant HCWs
Respirators for non-immune persons
that must enter
Susceptible high-risk contacts should
receive varicella zoster
immunoglobulin as soon as possible,
latest within 96 hours of exposure
Varicella zoster immunoglobulin may
extend the incubation period to 28
days
Refer to Canadian Immunization for
specific information, available at:
http://www.phacaspc.gc.ca/publicat/cig-gci/indexeng.php
36 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Clinical
presentation
Precautions
Infective
material
Route of
transmission
Incubation
period
Period of
communicability
Duration of
precautions
Herpes zoster
(shingles),
disseminated
Vesicular skin
lesions
Airborne and
Contact
Vesicle fluid,
respiratory
secretions
Airborne, direct
and indirect
contact
Until all lesions
Until all
have crusted and lesions have
dried
crusted and
dried
Herpes zoster,
localized Immunocompromised host
Vesicular skin
lesions in
dermatomal
distribution
Airborne and
contact
Vesicle fluid
Direct and
indirect
contact,
airborne
Until all lesions
have crusted and
dried and
disseminated
infection is ruled
out
Herpes zoster,
localized
Normal host
Vesicular skin
lesions in
dermatomal
distribution
Routine
Contactbb and
airborne
Vesicle fluid
Until all lesions
Until all
have crusted and lesions have
crusted and
dried
dried
Airborne
Respiratory
secretions
Direct and
indirect
contact,
possibly
airborne
Airborne
Varicella or herpes Susceptible
zoster contact
contact
Variola
See smallpox
10–21 days
Potentially
communicable
during last 2
days of
incubation period
Until 24 hours
after antiviral
therapy
started; then
as for
localized
zoster in
normal host
From 8 days
after first
contact until
21 days after
last contact
with rash,
regardless of
postexposure
vaccination
(28 days if
given varicella
zoster
immunoglobulin)
Comments
HCWs, roommates and caregivers
should be immune to chickenpox
Respirators for non-immune persons
that must enter
Susceptible high-risk contacts should
receive varicella zoster
immunoglobulin as soon as possible,
latest within 96 hours of exposure
Varicella zoster immunoglobulin may
extend the incubation period to 28
days
Localized zoster may disseminate in
immunocompromised host if not
treated
HCWs, roommates and caregivers
should be immune to chickenpox
Susceptible high-risk contacts should
receive varicella zoster
immunoglobulin as soon as possible,
latest within 96 hours of exposure
Varicella zoster immunoglobulin may
extend the incubation period to 28
days
bb
Consider contact and airborne for
cases of extensive localized zoster
that cannot be covered, in situations
where there are varicella susceptible
patients/HCWs.
Airborne precautions should be taken
with neonates born to mothers with
varicella onset <5 days before
delivery
HCWs, roommates and caregivers
should be immune to chickenpox
.
47 | ROUTINE PRACTICES AND ADDITIONAL PRECAUTIONS FOR PREVENTING THE TRANSMISSION OF INFECTION IN HEALTHCARE
SETTINGS
Microorganism
Vibrio
parahaemolyticus
enteritis
Vincent’s angina
(trench mouth)
Viral hemorrhagic
fevers
(Lassa, Ebola,
Marburg, CrimeanCongo viruses)
West Nile virus
See Arboviruses
Whipworm
See Trichuriasis
Whooping cough
See Pertussis
Yersinia
enterocolitica; Y.
pseudotuberculosi
s
Zoster
See Varicella
(Herpes zoster)
Zygomycosis
(Phycomycosis)
See Mucormycsis
Clinical
presentation
Diarrhea, food
poisoning
Precautions
Routine
Infective
material
Route of
transmission
Incubation
period
Contaminated
food,
especially
seafood
Foodborne
Between 12
and 24 hours;
range from 4–
30 hours
Lassa: 1–3
weeks
Ebola: 2–21
days
Period of
communicability
Duration of
precautions
Comments
Routine
Hemorrhagic
fever
Contact and
droplet
AGMPcc
Blood and
bloody body
fluids,
respiratory
secretions
Lassa: urine
Direct and
Indirect contact
Lassa: Sexual
contact
Diarrhea,
mesenteric
adenitis
ADULT:
Routinedd
PAEDIATRIC:
Contact
Feces
Direct and
3–7 days,
indirect contact generally
(fecal/oral);
under 10 days
foodborne
Unknown,
possibly several
weeks
Lassa virus may
be excreted in
urine for 3–9
weeks after
onset
Until
symptoms
resolve
Local public health authorities should
be notified immediately.
cc
AGMP necessary: see strategies to
reduce aerosol generation, see Part
B, Section IV, subsection iii, 1b
Duration of
excretion in stool
Duration of
symptoms
dd
Consider contact precautions for
incontinent adults if stool cannot be
contained or for adults with poor
hygiene who contaminate their
environment
Contact precautions apply to children
who are incontinent or unable to
comply with hygiene
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IH0200:
EFFECTIVE DATE: September 2006
Airborne Precautions
REVISED DATE: April 2011, January 2015,
November 2016
REVIEWED DATE:
1.0
PURPOSE
Airborne Precautions refer to infection prevention and control interventions to be used in addition
to Routine Practices to prevent transmission of airborne particles that remain suspended in the air,
travel on air currents and are then inhaled by others who are nearby or who may be some distance
away from the source patient, in a different room or ward (depending on air currents) or in the same
room that a patient has left, if there have been insufficient air exchanges. Common microorganisms
transmitted by the airborne route are Mycobacterium tuberculosis (TB), varicella virus (chickenpox
virus) and measles virus.
2.0
DEFINITIONS
Airborne Precautions – measures used for diseases that are spread by airborne transmission. This
primarily occurs through dissemination of microorganisms by aerosolization. Organisms are
contained in droplet nuclei which are small airborne particles, less than 5 microns in size that result
from evaporation of large droplets. Organisms can also be contained in debris in dust particles that
remain suspended in the air for long periods of time. These microorganisms are then widely
dispersed by air currents and can be inhaled by susceptible hosts who may be some distance away
from the source patient. Control of airborne transmission is the most difficult, as it requires control of
air flow through special ventilation systems and use of respirators.
Conditions/clinical presentations and specific etiologies requiring airborne precautions:
Conditions/clinical presentation
*
Cough, fever, pulmonary infiltrate in
person at risk for TB
(pleuropulmonary or laryngeal TB)
Rash, maculopapular with fever and
one of coryza, conjunctivitis or
cough
Rash, vesicular with fever
Specific etiologies
*
*
*
*
*
Measles (rubeola)
Monkeypox
Tuberculosis (pleuropulmonary or laryngeal)
■ nonpulmonary lesions, during
procedures that may aerosolize tuberculi
bacilli
Smallpox
Varicella zoster virus
■ varicella (chicken pox)
■ zoster, disseminated
■ zoster in immunocompromised patient
*Use Airborne & Contact Precautions
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 2
Aerosol-generating medical procedures (AGMPs) - are medical procedures that can generate
aerosols as a result of artificial manipulation of a patient’s airway. Examples include intubation,
manual ventilation, open endotracheal suctioning, CPR, bronchoscopy, sputum induction, nebulized
therapy, surgery, autopsy, and non-invasive positive pressure ventilation (CPAP, BiPAP)
Airborne Isolation Room – a single patient room that is equipped with special air handling (negative
pressure) and ventilation capacity.
Anteroom – is considered a clean area and is used to transition people in and out of the airborne
isolation room when it is under negative pressure. An anteroom is used as a transitional space
between the hallway and the airborne isolation room. This transition area is where the Healthcare
Worker puts on their PPE when entering the Airborne isolation room. The HCW also will store all
clean PPE in this area.
See Anteroom Protocol
Negative Pressure Room – also known as an Airborne Isolation Room; a negative pressure room
that is a single-occupancy patient-care room used to isolate persons with a suspected or confirmed
airborne infectious disease.
N95 Respirators – specific masks that filter particles one micron in size, have a 95% filter efficiency
and provide a tight facial seal with less than a 10% leak.
3.0 GUIDING PRINCIPLES
3.1.
Maintain a high degree of suspicion for those patients who present with compatible symptoms of
an airborne infection, prompt implementation of airborne precautions and rapid diagnosis.
3.2. For the purpose of this guideline, the term Airborne Isolation Room will be used to
refer to a “negative pressure room”. An Airborne Isolation Room must have:

Ventilation creating inward directional airflow from adjacent spaces to the room (‘negative
pressure’) that is regularly monitored.

Direct exhaust of air from the room to the outside of the building or recirculation of air
through a HEPA filter before returning to circulation.

Twelve (12) air changes per hour.

The door into the room kept closed to maintain negative pressure, even if the patient is
not in the room.

Windows closed at all times; opening the window may cause reversal of air flow, an
effect that can vary according to wind direction and indoor/outdoor temperature differentials.
All healthcare providers in high risk areas must be fit tested for an N95 respirator.
REFER TO AV 1900 RESPIRATORY PROTECTION PROGRAM POLICY (NOT AVAILABLE
TO NON IH FACILITIES)
3.3. Only immune healthcare providers should enter a room where airborne precautions are in place for
measles or varicella; an N95 respirator is not required.
3.4. An N95 respirator must be worn if non-immune health care providers are required to enter the room
of a patient with measles or varicella when there are no qualified immune health care providers
available and patient safety would be compromised if they did not provide care.
A point of care risk assessment for every patient interaction needs to be done to determine
additional precautions, room placement and PPE:
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 3
Clinical Syndromes Requiring the Use of Controls (Including PPE) Pending Diagnosis







4.0
Acute diarrhea and / or vomiting of suspected infectious etiology:
o GLOVES, SINGLE ROOM
o GOWN if skin or clothing will come into direct contact with the patient or the
patient’s environment and for paediatrics and incontinent/non-compliant adults
Acute respiratory infection, undiagnosed:
o SINGLE ROOM/SPATIAL SEPARATION preferred, FACIAL PROTECTION,
GLOVES
o GOWN if skin or clothing will come into direct contact with the patient or the
patient’s environment
Respiratory infection with risk factors and symptoms suggestive of Tuberculosis:
o FIT-TESTED N95 RESPIRATOR, NEGATIVE PRESSURE ROOM
Suspected meningitis and/or sepsis with petechial rash:
o SINGLE ROOM, FACIAL PROTECTION
Undiagnosed rash without fever:
o GLOVES
Rash suggestive of varicella or measles:
o NEGATIVE PRESSURE ROOM -= only immune staff to enter
Abscess or draining wound that cannot be contained:
o GLOVES
o GOWN if skin or clothing will come into direct contact with the patient
PROCEDURE
As well as Routine Practice, Airborne Precautions includes the following:
4.1
Source Control
a) A point of care risk assessment (PCRA) as per routine practices should be done to
determine if airborne precautions are required.
 Note that some diseases/conditions require two precaution categories;
airborne and contact – see table above
 Patients should be directed to put on a surgical/procedure mask, if tolerated
when not in an airborne isolation room.
 Place patients directly into an airborne isolation room with door closed.

If a facility does not have an airborne isolation room, patient to
be placed into a single room; the patient should be instructed to keep the mask
on and the door should remain closed. Transfer as soon as possible to a facility
with an airborne isolation room.

Signage placed at the entrance to patient room.
b) The following strategies should be applied to reduce the level of aerosol generation when
performing aerosol-generating medical procedures (AGMPs) for patients with
suspected airborne disease.
 AGMPs should be limited to those that are medically necessary.
 The number of personnel in the room should be limited to those required.
 Consider appropriate patient sedation.
 AGMPs should be performed in an airborne isolation room.
 Single rooms (with the door closed and away from high-risk patients), should be used
in settings where airborne isolation rooms are unavailable.
 N 95 respirators should be worn by all personnel in the room during the procedure.
 Closed endotracheal suction systems should be used wherever possible.
 In an emergency situation when an airborne isolation room is not available; at a
minimum pull the privacy curtains and all personnel to wear N95 respirator. Remove
visitors and other patients from the room/area.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 4
c) Intubated and ventilated patients
 An appropriate bacterial filter should be placed on the endotracheal tube to
prevent contamination of the ventilator and the ambient air.
 Endotracheal suctioning should be performed using a closed suction apparatus,
where possible.
4.2
Hand Hygiene
Perform hand hygiene as per hand hygiene guidelines IF0200.
4.3
Patient placement and accommodation:
 Place patient in airborne isolation room
 The airborne isolation room should have a toilet and sink for the patient, and a
designated hand washing sink for healthcare workers.
 Monitoring – ensure pressure differentials are correct and indicators/alarms are activated.
4.4
Patient flow/transport
 Communication is essential when a patient goes to another department for testing, to
another unit or to other healthcare settings/facilities. This communication must include
Emergency Medical Services (EMS) staff and other transport staff.
 Patients should be restricted to their room, unless medically necessary.
 Patient must wear surgical/procedure mask during transport.
 If the patient needs to be transported and cannot wear a mask, transport should be
planned to limit the exposure of other individuals (e.g. no waiting in the reception areas,
transport in empty elevator) and it should be communicated to receiving personnel so
that consistent precautions can be maintained. The transport personnel should wear an
N95 respirator during transport.
4.5
Personal Protective Equipment (PPE)
 Healthcare worker to wear appropriately fit-tested N95 respirator upon entering room and
when assisting or performing AGMPs.
Appropriate respirator use:
 Hand hygiene should be performed prior to putting on a respirator.
 A seal check should be performed.
 Respirators should be carefully removed by the straps to avoid selfcontamination.
 A respirator should not dangle around the neck when not in use.
 The respirator should be changed if it becomes wet or soiled (from the wearer’s
breathing or an external splash).
 The respirator should be discarded immediately after use, followed by hand
hygiene.
4.6
Management of patient care equipment
 As per routine practices. If contact precautions are also in use, then refer to Contact
Precautions Guideline 3.6.
4.7
Cleaning of patient environment
 As per routine practices. If contact precautions are also in use, then refer to Contact
Precautions Guideline 3.7.
4.8
Education of patient, family and visitors
 Educate as per Airborne Precautions signage.
 Visitors should be limited.
 Visitors should be counseled about their risk and advised to wear an N95 respirator.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 5
4.9
Duration of precautions
 Airborne precautions should be discontinued after signs and symptoms of the infection
have resolved or as per Transmission Tables.
o REFER TO IH0100 TRANSMISSION TABLES

Upon discharge or discontinuation of airborne precautions door must remain closed and
negative air flow maintained until all air in the room has been replaced. Requires 45
minutes.
4.10
Management of deceased bodies
 Airborne precautions should be used for handling deceased bodies and preparing bodies
for autopsy or transfer to mortuary services.
 Airborne precautions should be continued for the handling of a patient with infectious
respiratory tuberculosis, measles or varicella until appropriate time has elapsed to
remove airborne contaminants in the room - Requires 45 minutes.
4.11
Airborne precautions for Residential Care
In addition to routine practices:
 Resident to be placed into a single room; the resident should be instructed to keep a
mask on and the door should remain closed. Transfer as soon as possible to a facility
with an airborne isolation room.
4.12
Airborne precautions for Clients in a Home Environment
In addition to routine practices:
 The healthcare worker should wear a fit-tested N95 respirator.
5.0
REFERENCES
5.1
Routine Practices and Additional Precautions In all Healthcare Settings. Provincial Infectious
Diseases Advisory Committee (PIDAC), Ontario; November 2012.
5.2
Routine Practices and Additional Precautions for Preventing the Transmission of Infection in
Health Care Settings; Public Health Agency of Canada; 2013.
5.3
Routine Practices and Additional Precautions Assessment and Educational Tools. Public
Health Agency of Canada; 2013.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 6
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 7
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 8
Point of Care Risk Assessment is on the backside of each Precautions Sign
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 9
Airborne Precautions Sign - Form #807900
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 10
Airborne & Contact Precautions Sign - Form #807901
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 11
Airborne Communicable Disease Algorithm - Form #807907
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 12
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H-1H0200 (Airborne Precautions)
Page 13
Airborne Isolation Room – Anteroom Protocol
EFFECTIVE DATE: February 2011
REVISED DATE:
1.0
PURPOSE
An anteroom is used as a transitional space between the hallway and the airborne isolation room.
This transition area is where the Health Care Worker puts on their PPE when entering the Airborne
isolation room. The HCW also will store all clean PPE in this area.
2.0
DEFINITIONS
Anteroom - anteroom is considered a clean area and is used to transition people in and out of the
airborne isolation room when it is under negative pressure.
3.0
GUIDING PRINCIPLES
3.1
During Airborne Precautions.




3.2
The anteroom is to be used for anyone entering or exiting the patient room when the
room is used for airborne precautions.
The laundry hamper shall be situated just inside the patient room when additional
precautions are in place.
The only items that should be stored in this room include:
o PPE ( N95 respirators, procedure masks, gowns, eye protection, gloves).
o Garbage container.
o Alcohol based hand rub (ABHR) in a holder.
o Disinfectant wipes in a holder.
o Precaution signs.
o Hand soap in a holder.
o Paper towels in a holder.
Posters could include – hand hygiene, donning and doffing, instructions for families.
No Additional Precautions in use.
o
o
o
o
4.0
DO NOT USE the room for storage.
May be used to go in and out of patient room.
Use for hand hygiene prior to entering and on exit from room.
May be used to don PPE as necessary for routine practices.
PROCEDURE
4.1
During Airborne Precautions:
1.0 Doors to and from the anteroom and the patient room shall remain closed when the
room is used for airborne precautions.
2.0 Perform hand hygiene in the anteroom on entrance and exit from room.
3.0 Put personal protective equipment (PPE) on before entering the patient room.
4.0 Remove the N95 respirator in the anteroom after you have closed the door to the
patient room.
For airborne/contact precautions remove the gown and gloves just inside the patient room, and then remove
the N95 respirator in the anteroom after you have closed the door to the patient room.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 1
IH0300:
Droplet Precautions
EFFECTIVE DATE: September 2006
REVISED DATE: April 2011, September 2014
February 2015, November 2016
REVIEWED DATE:
1.0
PURPOSE
Droplet Precautions refer to infection prevention and control interventions to be used in
addition to Routine Practices and are intended to prevent transmission of pathogens spread
through close respiratory or mucous membrane contact with respiratory secretions.
2.0
DEFINITIONS
Droplet Precautions – measures used for diseases that are spread by direct contact through
droplet transmission. Droplet transmission refers to large droplets, greater than 5 microns in
diameter, generated from the respiratory tract of the source patient during coughing or sneezing,
or during procedures such as suctioning or bronchoscopy. These droplets are propelled a short
distance of less than two metres (6 feet) through the air and deposited on the nasal, oral or
conjunctival mucosa of the new host or fall onto surfaces. Large droplets do not remain
suspended in the air. Special ventilation is not required since true aerosolization does not occur.
Droplet/Contact Precautions - microorganisms contained in these droplets can be deposited on
surfaces in the patient’s immediate environment and some microorganisms remain viable for
extended periods of time. Contact transmission can then occur by touching surfaces and objects
contaminated with respiratory droplets.
A point of care risk assessment for every patient interaction needs to be done to determine
additional precautions, room placement and PPE:
Clinical Syndromes Requiring the Use of Controls (Including PPE) Pending Diagnosis







Acute diarrhea and / or vomiting of suspected infectious etiology:
o GOWN if skin or clothing will come into direct contact with the patient or the
patient’s environment and for pediatrics and incontinent/non-compliant adults
Acute respiratory infection, undiagnosed:
o SINGLE ROOM/SPATIAL SEPARATION preferred, FACIAL PROTECTION,
GLOVES
o GOWN if skin or clothing will come into direct contact with the patient or the
patient’s environment
Respiratory infection with risk factors and symptoms suggestive of Tuberculosis:
o FIT-TESTED N95 RESPIRATOR, NEGATIVE PRESSURE ROOM
Suspected meningitis and/or sepsis with petechial rash:
o SINGLE ROOM, FACIAL PROTECTION
Undiagnosed rash without fever:
o GLOVES
Rash suggestive of varicella or measles:
o NEGATIVE PRESSURE ROOM -= only immune staff to enter
Abscess or draining wound that cannot be contained:
o GLOVES
o GOWN if skin or clothing will come into direct contact with the patient
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 2
Conditions/clinical presentations and specific etiologies requiring droplet precautions:
Conditions/clinical presentations
Specific etiologies
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Bronchiolitis
Cellulitis, in child <5 years old if
Haemophilus influenzae type B possible
Cold
Cough, fever, acute respiratory tract
infection
Croup
Epiglottis in child <5 years old
Febrile respiratory illness
Hemorrhagic fever in epidemiologic
context
Influenza-like illness
Meningitis
Osteomyelitis, in children if H. influenzae
possible
Paroxysmal cough, suspected pertussis
Pharyngitis
Pneumonia, in children
Rash, macupapular with fever and one of
coryza, conjunctivitis or cough
Rash, petechial/purpuric with fever
Rash, vesicular, pustular with
epidemiologic
context or viral hemorrhagic fever
Septic arthritis, in children if H. influenzae
possible
Toxic shock syndrome, if Group A
Streptococcus possible
*
*
*
*
*
*
*
*
Adenovirus, respiratory strains
Bocavirus
Coronavirus
Diphtheria, pharyngeal
H. influenzae, in children
Human metapneumolvirus
Influenza, seasonal, avian
Meningococcus
Monkeypox – use airborne/contact
Mumps
Mycoplasma pneumoniae
Parainfluenza virus
Parvovirus B-19, aplastic crisis or chronic
infection in immunocompromised patient
Pertussis
Plague, pneumonic
Respiratory syncytial virus
Rhinovirus
Rubella
Severe acute respiratory syndrome
Smallpox – use airborne/contact
Staphylococcus aureus in children with
pneumonia
Streptococcus, Group A
■ scarlet fever or pharyngitis in
children
■ invasive disease
Viral hemorrhagic fevers (Crimean-Congo,
Ebola, Lassa, Marburg)
* Use Droplet & Contact Precautions
3.0
PROCEDURE
As well as Routine Practice, Droplet Precautions includes the following:
3.1
Source Control
 A point of care risk assessment (PCRA) as per routine practice should be done to
determine if droplet precautions are required.
 Note that some diseases/conditions require two precaution categories – see
table above.
 Signage placed at the entrance to the patient room, cubicle or designated bed space.
 Educate patients about respiratory hygiene. Once patient is in their room, the mask
can be removed.
 Droplet precautions in addition to routine practices are sufficient for aerosolgenerating medical procedures (AGMP) performed on patients on droplet precautions
who have no signs or symptoms of suspected or confirmed airborne illness.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 3
3.2
Hand Hygiene
 Perform hand hygiene as per IF0200 (Hand Hygiene Guidelines)
3.3
Patient placement and accommodation PRIVATE ROOM ALGORITHM
 Single room with toilet and hand washing sink preferred.
o Door may remain open.
o Signage placed at the entrance to the patient room, cubicle or designated
bed space.
o In Emergency rooms place signage on privacy curtain around cubicle.
 Cohort
o Cohort patients who are infected or colonized with the same microorganism
and are suitable roommates.
 Shared Room – when cohorting is not feasible:
o Maintain spatial separation of at least 2 metres between patients
o Privacy curtains between beds should be drawn to minimize opportunity for
droplet spread
o Roommates should be selected based on their ability to comply with
precautions.
o Roommates should not be at high risk for serious disease if transmission
occurs
o Droplet precautions should be applied in nursery settings.
3.4
Patient flow/transport:
 Communication is essential when a patient goes to another department for testing, to
another unit or to other healthcare settings/facilities. This communication must
include Emergency Medical Services (EMS) staff and other transport staff.
 The patient should wear a mask if tolerated and follow respiratory hygiene during
transport.
 If the patient cannot tolerate wearing a mask, transport staff should wear a
surgical/procedure mask and eye protection.
Remind patients to adhere to the 4 C’s when outside of their room.

3.5
Patients should not use common areas of hospital such as lounge or go into other
patient rooms.
Personal Protective Equipment (PPE)
 PPE should be provided outside the patient room, cubicle or patient’s designated bed
space in shared room.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 4


A surgical/procedure mask and eye protection should be worn
o When within two metres (6 feet) of the patient.
o Remove PPE and discard before leaving the room or bed space and do hand
hygiene.
The same PPE should not be worn for more than one patient.
3.6
Cleaning and disinfection of non-critical patient care equipment
 As per routine practices. If contact precautions are also in use, then refer to Contact
Precautions Guideline 3.6.
3.7
Cleaning of patient environment
 As per routine practices. If contact precautions are also in use, then refer to Contact
Precautions Guideline 3.7.
3.8
Waste, laundry, dishes and cutlery
 As per routine practices
3.9
Education of patient, families and visitors
 Educate as per droplet precautions signage.
 Recommend visit only one patient.
 Wear surgical/procedure mask and eye protection when within 2 metres of patient.
 For pediatrics, household contacts can choose not to wear PPE, as they will have
already been exposed in the household.
3.10
Duration of Precautions:
 Droplet precautions should be discontinued after signs and symptoms of the infection
have resolved or as per Transmission Tables
REFER TO IH0100 TRANSMISSION TABLES
3.11
3.12
Management of deceased bodies
 Routine practices, properly and consistently applied, should be used for handling
deceased bodies and preparing bodies for autopsy or transfer to mortuary services.
 Droplet precautions are not necessary
Droplet Precautions for Residential Care
In addition to Routine Practices:
 A point of care risk assessment should be done to determine if droplet precautions
are required – signage is available.
 Wear surgical/procedure mask and eye protection when within 2 metres of
symptomatic resident.
 More commonly used in combination with contact precautions.
 Restrict activities while resident is symptomatic.
3.13
Droplet Precautions for Emergency and Ambulatory Care Settings
In addition to routine practices:
 Triage – a point of care risk assessment must be done to determine if droplet
precautions are required.
 Contact between symptomatic patients and others should be avoided by minimizing
time spent in waiting rooms.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 5


3.14
Patient should be separated from other patients by at least two metres.
Symptomatic patients should be scheduled at a time when they are less likely to
encounter other patients.
Droplet Precautions for Clients in a Home Environment
In addition to Routine Practices:
 Healthcare workers should screen clients for respiratory illness by phone, prior to the
homecare visits, whenever possible.
 Ensure mask and eye protection are worn when within two metres of symptomatic
client.
Symptomatic clients in the home should be advised to:
 Stay home until symptoms resolved
 If medical appointment necessary – advise of symptoms
4.0
REFERENCES
4.1
Routine Practices and Additional Precautions In all Healthcare Settings. Provincial
Infectious Diseases Advisory Committee (PIDAC), Ontario; November 2012.
4.2
Routine Practices and Additional Precautions for Preventing the Transmission of
Infection in Health Care Settings; Public Health Agency of Canada; 2013.
4.3
Routine Practices and Additional Precautions Assessment and Educational Tools.
Public Health Agency of Canada; 2013.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 6
Point of Care Risk Assessment is on the backside of each Precautions sign
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 7
Droplet Precautions Sign - Form #807903
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0300 (Droplet Precautions)
Page 8
Droplet & Contact Precautions Sign - Form #807904
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IH0400:
Contact Precautions
EFFECTIVE DATE: September 2006
REVISED DATE: June 2014,
September 2014, November 2016
REVIEWED DATE:
1.0
PURPOSE
Contact Precautions refer to infection prevention and control interventions to be used in
addition to Routine Practices and are intended to prevent transmission of infectious
agents, including epidemiologically important microorganisms, which are spread by direct or
indirect contact.
4.0
DEFINITIONS
Contact Precautions – measures used for diseases caused by epidemiologically important
micro organisms that may be transmitted easily by contact with the patient's intact skin or with
contaminated environmental surfaces (e.g. Clostridium difficile, MRSA, VRE, RSV). These
infections can be transmitted even if the organism has a low infective dose and there is
potential for widespread environmental contamination.
A point of care risk assessment for every patient interaction needs to be done to
determine additional precautions, room placement and PPE:
Clinical Syndromes Requiring the Use of Controls (Including PPE) Pending Diagnosis







Acute diarrhea and / or vomiting of suspected infectious etiology:
o GLOVES, SINGLE ROOM
o GOWN if skin or clothing will come into direct contact with the patient or the
patient’s environment and for paediatrics and incontinent/non-compliant adults
Acute respiratory infection, undiagnosed:
o SINGLE ROOM/SPATIAL SEPARATION preferred, FACIAL PROTECTION,
GLOVES
o GOWN if skin or clothing will come into direct contact with the patient or the
patient’s environment
Respiratory infection with risk factors and symptoms suggestive of Tuberculosis:
o FIT-TESTED N95 RESPIRATOR, NEGATIVE PRESSURE ROOM
Suspected meningitis and/or sepsis with petechial rash:
o SINGLE ROOM, FACIAL PROTECTION
Undiagnosed rash without fever:
o GLOVES
Rash suggestive of varicella or measles:
o NEGATIVE PRESSURE ROOM -= only immune staff to enter
Abscess or draining wound that cannot be contained:
o GLOVES
o GOWN if skin or clothing will come into direct contact with the patient
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 1
Conditions/clinical presentations and specific etiologies requiring contact precautions:
Specific etiologies
*
*
*
*
*
*
*
*
*
*
*
*
*
Acute viral respiratory infections
■ bronchiolitis
■ cold
■ croup
■ cough, fever, acute upper
respiratory infection
■ febrile respiratory illness
■ fever without focus, acute,
children
■ influenza-like illness
■ pharyngitis
Conjunctivitis
Dermatitis
Desquamation, extensive
Diarrhea
Draining wounds, major wound
infection, abscess, infected
pressure ulcer or other skin infection
if drainage cannot be contained by
dressings
Encephalitis, paediatric
Endometritis with signs of toxic shock
Food poisoning
Gastroenteritis
Gingivostomatitis, primary
Hand, foot and mouth disease,
children
Hemolytic uremic syndrome, contact
Hemorrhagic fever
Hepatitis of unknown origin, children
Herpangina, children
Meningitis
Necrotizing enterocolitis, children
Pleurodynia, children
Pseudomembranous colitis
Rash, compatible with scabies
Rash, vesicular with fever
Rash, vesicular/pustular, with
epidemiologic context of viral
hemorrhagic fever
*
*
*
*
*
Adenovirus
Adenovirus, conjunctivitis
Amebiasis, children
Antibiotic-resistant
organisms
Astrovirus, children
Bocavirus
Brucellosis, major draining
lesions
Burkholderia cepacia
Campylobacter
Cholera, children
Clostridium difficile
Coronavirus
Cryptosporidiosis, children
Diphtheria, cutaneous
Enteroviral infections,
children
Enteroviral conjunctivitis
Escherichia coli
(enteropathogenic and
enterohemorrhagic
strains)
Giardia
Hepatitis A, E, children
Herpes simplex virus
■ encephalitis, children
neonatal
■ neonatal or
mucocutaneous
Human metapneumovirus
Influenza seasonal, avian
Monkeypox - use
airborne/contact
Norovirus –
droplet/contact in
outbreak
*Use Droplet & Contact Precautions
Note: in this document the term “patient” is inclusive of patient, resident or client.
*
*
*
*
*
*
*
Parainfluenza virus
Poliomyelitis, acute infantile
Respiratory syncytial virus
Rhinovirus
Rotavirus
Rubella, congenital
Salmonella
Scabies
Severe acute respiratory
syndrome
Shigella
Smallpox - use
airborne/contact
Staphylococcus aureus,
major draining wound
Streptococcus, Group A,
major draining wound
invasive disease
or toxic shock syndrome
Vaccinia
Vancomycin resistant
enterococci
Vancomycin-resistant
Staphylococcus aureus
Varicella-zoster virus
■ varicella – use
airborne/contact
■ herpes zoster,
disseminated or
localized in
immunocompromised
host, localized in normal
host if not contained
Viral hemorrhagic fevers
(Crimean-Congo, Ebola,
Lassa,
Marburg)
Yersinia enterocolitica
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 2
5.0
PROCEDURE
As well as Routine Practices, Contact Precautions include the following:
3.1 Source control
 A point of care risk assessment (PCRA) as per routine practice should be done to
determine if contact precautions are required.
 Note that some diseases/conditions require two precaution categories – see
table above
 Signage placed at the entrance to the patient room, cubicle or designated bed space
 Contact precautions in addition to routine practices are sufficient for aerosolgenerating medical procedures (AGMP) performed on patients on contact
precautions who have no signs or symptoms of suspected or confirmed airborne
illness
3.2 Hand Hygiene
 Perform hand hygiene as per IF0200 (Hand Hygiene Guidelines)
3.3 Patient placement and accommodation. PRIVATE ROOM ALGORITHM
 Single room with toilet, patient sink and hand washing sink preferred.

Door may remain open.
 Signage placed at the entrance to the patient room, cubicle or designated bed
space
 In Emergency Rooms place signage on privacy curtain around cubicle.
 Cohort
o Cohort patients who are infected or colonized with the same microorganism and
are suitable roommates
 Shared Room – when cohorting is not feasible:
o Maintain spatial separation of at least 2 metres between patients.
o Roommates should be selected based on their ability to comply with precautions
o Roommates should not be at high risk for serious disease if transmission occurs.
o A patient with diarrhea should not share a toilet with another patient.
o Contact Precautions should be applied in nursery settings.
3.4



Patient Flow/Transport
Communication is essential when a patient goes to another department for testing, to
another unit or to other healthcare settings/facilities. This communication must
include Emergency Medical Services (EMS) staff and other transport staff.
Personal protective equipment should be removed and disposed of and hand
hygiene performed, prior to transporting patients.
Health care provider to wear gloves and gown for direct contact with patient during
transport.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 3
Remind patients to adhere to the 4 C’s when outside of their room.


Patients do not need to wear gloves and isolation gown when outside the room
Patients should not use common areas of hospital such as lounge or go into other patient
rooms.
3.5
Personal Protective Equipment (PPE)
 Personal protective equipment should be provided directly outside the patient room,
cubicle or patient’s designated bed space in shared rooms.
 Use gloves and gown when in direct contact with patient or patient environment.
 Remove gown and gloves and discard before leaving the room or bed space and
do hand hygiene.
 The same personal protective equipment should not be worn for more than one
patient.
3.6
Cleaning and disinfection of non-critical patient care equipment
 Dedicate patient care equipment (e.g. blood pressure cuff, commodes etc.).
 If equipment must be shared it must be cleaned and disinfected between patients.
 Do not take extra supplies into patient’s room.
3.7
Cleaning of the patient environment
 When precautions are discontinued or the patient is moved, do an additional
precautions discharge clean of the room/bed space and bathroom which includes
changing privacy curtains and cleaning and disinfecting or changing string/cloth call bells
or light cords.

For Clostridium difficile Infections (CDI) please refer to the CDI cleaning poster
3.8
Waste, laundry, dishes and cutlery
 Use routine practices
3.9
Education of patients, families and visitors
 Educate as per contact precautions signage.
 Recommend visit only one patient.
 Visitors to wear gloves and gown if participating in direct patient care.
 Visitors to remove gloves and gown and perform hand hygiene prior to leaving room.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 4
3.10
Duration of precautions
 Contact precautions should be discontinued after signs and symptoms of the infection
have resolved or as per Transmission Tables.
REFER TO IH0100 TRANSMISSION TABLES
 Precautions should be discontinued only after the room/bed space and bathroom has
been isolation discharge cleaned.
3.11
Management of deceased bodies
 Contact precautions should be used for handling deceased bodies, preparing bodies for
autopsy or for transfer to mortuary services.
3.12
Contact Precautions for Residential Care
In addition to Routine Practice:
 A point of care risk assessment should be done to determine if contact precautions are
required – signage is available.
 Restrict activities if wound drainage or diarrhea cannot be contained.
 Follow the 4 C’s as in box above.
3.13
Contact Precautions for Emergency and Ambulatory Care Settings
In addition to Routine Practice:
 Triage - a point of care risk assessment must be done to determine if contact
precautions are required.
 Contact between symptomatic patients and others should be avoided by minimizing time
spent in waiting rooms.
 Placement in a separate room/area should be done as soon as possible.
 Symptomatic patients should be scheduled at a time when they are less likely to
 encounter other patients unless they can be placed directly into a separate room
 Additional precautions discharge clean required only for patients with uncontained
draining wounds, diarrhea or vomiting or uncontrolled respiratory secretions – need to
have good communication between patient care staff and housekeeping regarding
additional cleaning required.
3.14
Contact Precautions for Clients in a Home Environment
In addition to Routine Practice:
Symptomatic clients in the home should be advised to:
 Rest away from others, in a separate room, if available
 Use a designated bathroom, whenever possible
 Clean the bathroom frequently, especially frequently touched surfaces
 Not share towels or other personal items
 Stay home until symptoms resolved
 If medical appointment necessary – advise of symptoms
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 5
6.0
REFERENCES
6.1
Routine Practices and Additional Precautions In all Healthcare Settings. Provincial
Infectious Diseases Advisory Committee (PIDAC), Ontario; November 2012.
6.2
Routine Practices and Additional Precautions for Preventing the Transmission of
Infection in Health Care Settings; Public Health Agency of Canada; 2013.
6.3
Routine Practices and Additional Precautions Assessment and Educational Tools.
Public Health Agency of Canada; 2013.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 6
Point of Care Risk Assessment is on the backside of all Precautions signs
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 7
Contact Precautions Sign - Form #807902
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 8
Contact Plus Precautions – Form #807914
Used for Clostridium Difficile Infection (CDI) Only
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0100 (Reportable Communicable Diseases)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0100:
Reportable Communicable Diseases
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
February 2015
REVIEWED DATE:
1.0
PURPOSE
To reduce the risk of transmission of communicable diseases within healthcare facilities and to programs.
2.0
GUIDING PRINCIPLES
2.1. The Infection Prevention and Control Practitioners will facilitate processes to ensure the
Reportable Communicable Diseases are reported to Public Health both from the clinical setting
and the laboratory setting, using the LIST OF COMMUNICABLE DISEASES IN BC JULY 2009.
2.2. THE Communicable Disease Regulation states in Section 1.2.1 that any person knowing or
suspecting that another person is suffering from a communicable disease shall without delay
make a report to the medical health officer.
3.0
PROCEDURE
Contact the Infection Control Practitioner (ICP) as soon as possible when a patient who is known or a
suspect case of a Reportable Communicable Disease included in SCHEDULE A is admitted to the
facility/program. The ICP will advise regarding reporting process.

If the ICP is unavailable, contact the Communicable Disease (CD) Unit as soon as
possible at 1-866-778-7736.
The laboratory is responsible for reporting Schedule B diseases listed in the REPORTABLE
COMMUNICABLE DISEASES IN BC (JULY 2009) LIST.

IH Immediately Notifiable Communicable Diseases
Note: In this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 04H – IH0400 (Contact Precautions)
Page 2
Effective Date: Sept.2006 Revised Date: July 2009
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0200:
Clostridium difficile
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
December 2012, July 2015, November 2016
REVIEWED DATE:
1.0
PURPOSE
To prevent the transmission of Clostridium difficile infection (CDI) in healthcare facilities including
hospitals, residential care homes and community settings and to minimize the risk of complications
associated with CDI.
2.0
DEFINITIONS
Clostridium difficile (C. difficile) is a bacterium that causes mild to severe diarrhea and intestinal
conditions like pseudomembranous colitis (inflammation of the colon). C. difficile is the most frequent
cause of healthcare associated infectious diarrhea in hospitals and residential care facilities and is
becoming more prevalent in the community.
Most cases of C. difficile occur in persons who are taking certain antibiotics which can destroy the
person’s normal bacteria found in the gut, causing C. difficile bacteria to grow. When this occurs, the
C. difficile bacteria produce toxins which can damage the bowel and cause diarrhea. Some people
can have C. difficile bacteria present in their bowel and not show symptoms. There are many
different strains of C. difficile and one strain known as NAP1 (North American Pulsed Filed type 1)
can cause serious illness.
C. difficile bacteria are found in feces and produce spores that are resistant many common types of
environmental disinfectants. These spores can live in the environment for long periods of time,
contaminating toilet areas and commodes. People can get infected if they touch surfaces
contaminated with the spores, and then touch their mouth. Healthcare workers can spread the
bacteria to their patients if their hands are contaminated.
C. difficile poses a particular risk to the elderly, pediatric and oncology patients and pregnant women.
Additional risk factors include antibiotic usage, proton pump inhibitor usage, bowel disease and bowel
surgery, prolonged hospitalization, and immunosuppressive therapy post-transplant.
Symptoms include watery diarrhea, fever, loss of appetite, nausea and abdominal pain/tenderness.
Persons are infectious while diarrhea is present.
Additional Precautions Twice Daily Clean with a Sporicidal Disinfectant – the type of clean
housekeeping uses for cleaning and disinfecting rooms/cubicles where a patient is on additional
precautions for C. difficile. Cleaning occurs twice daily, the second cleaning and disinfection is 6-8
hours after the first cleaning and disinfection and focuses on the high touch areas in the patient
room/area/space and bathroom (IH Housekeeping for Healthcare manual pg.87).
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 2
Additional Precautions Discharge Clean – refers to the cleaning and disinfection process of a
patient room when additional precautions is discontinued or the patient is discharged and includes
changing the privacy curtains (IH Housekeeping for Healthcare manual pg.109).
Best Practice Checklist for Management of CDI – is a tool used to monitor infection control
processes during usual CDI activity on a nursing unit and is NOT part of the patient chart. It can be
completed by either a nurse leader/educator or Infection Control Practitioners (ICPs).
Internal Alert – when the number of CDI cases in a unit or facility is above the pre-determined
threshold (trigger point) or there is suspected transmission. Internal alerts bring increased staff
awareness of CDI cases in the unit/facility so actions can be taken to prevent an outbreak. The
Infection Prevention and Control epidemiologist monitors the internal alert and informs the ICP when
the internal alert level is triggered at their site.
Outbreak Definition – CDI cases are classified as an outbreak when the number of new, timerelated, healthcare associated CDI cases in a unit or facility is above the expected threshold for that
unit or facility and where there is evidence of ongoing transmission despite appropriate interventions.
Declaring an outbreak must be done in conjunction with the facility Outbreak Management Team.
Outbreak Management Team – at a minimum, includes the site Infection Control Practitioner,
Infection Prevention and Control (IPAC) director, Medical Microbiologist and epidemiologist, site
administrator and medical director, nursing unit manager and housekeeping supervisor.
3.0
PROCEDURE
3.1
Additional Precautions
 Contact Precautions to be initiated at onset of diarrhea
3.2
Hand Hygiene
 Wash hands with soap and water (preferred)
 If no sink is in close proximity clean hands with alcohol-based hand rub (ABHR) and
wash with soap and water at first opportunity
 Do not perform hand hygiene at a patient sink, as this may cause contamination of the
healthcare provider’s. Use a dedicated staff hand washing sink
 Assist patients with cleaning their hands, especially after toileting and before meals
3.3
Patient Placement and Accommodation
 Place patient in a single room with a dedicated toilet on Contact Precautions
 Door may remain open
 Brown Contact Precautions signage placed at the entrance to the patient room, cubicle
or designated bed space (i.e.) Emergency Department
 If patients with C. difficile must be cohorted, each patient must be assigned their own
commode and kept at the bedside; cohort according to the stage of illness (i.e.) do not
cohort new onset CDI with a patient who is recovering and has no diarrhea
3.4
Patient Flow/Transport
 Transfers and/or bed moves should be avoided unless clinically necessary
 Communication of Contact Precautions is essential when a patient goes to another
department for testing, to another unit or to other healthcare settings/facilities including
communication with Emergency Medical Services (EMS) and other transport staff.
 PPE should be removed and hand hygiene performed, prior to transporting patients.
 If direct contact with patient is required during transport, then those staff must don PPE.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 3
3.5
Personal Protective Equipment
 PPE to be available directly outside the patient room, cubicle or designated bed space.
 Wear gloves and gown when in direct contact with patient or patient environment.
 Remove gown and gloves and discard before leaving the room or bed space and do
hand hygiene
3.6
Patient Care Equipment
 Dedicate equipment to a single patient
 Do not take extra supplies into patient’s room
 Promote “decluttering” initiatives to facilitate thorough cleaning of surfaces and
separation of clean and dirty items and equipment
 Do not take patient chart into the room.
 Clean and disinfect equipment used for transport after each use.
 Use the sporicidal wipes for cleaning and disinfecting equipment
3.7
Cleaning of Patient Environment
 Use a sporicidal product (accelerated hydrogen peroxide 4.5%) for cleaning and
disinfection
 Clean occurs twice daily, the second cleaning and disinfection is 6-8 hours after the
first cleaning and disinfection and focuses on the high touch areas in the patient
room/area/space and bathroom (IH Housekeeping for Healthcare manual pg.87).
 The brown Contact Plus Precautions sign alerts Housekeeping staff of the need for twice
daily cleaning with a sporicidal disinfectant, Contact Plus Precautions Sign
The physical act of friction is necessary to remove C. difficile spores.
3.8
Education of Patients, Families and Visitors
 Educate as per Contact Precautions signage
 Advise families and visitors not to use patient bathroom
 Provide the Clostridium difficile pamphlet to the patient and family located in the
Infection Prevention & Control website. (Not available to non IH facilities).
3.9
Discontinuation of Contact Precautions
 Precautions may be discontinued when the patient has had no diarrhea for 72 hours;
nursing staff to use Bristol Stool chart - Form #809505 to monitor diarrhea
 It is not necessary to have a negative specimen prior to discontinuing isolation – no
retesting is done within 30 days of previous positive result
 Housekeeping will do an additional precautions discharge clean of patient room when
Contact Precautions are discontinued
 Patient to shower/bathe and put on clean clothes, then go into cleaned bed space
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 4
3.10
Relapse of Symptoms
 Relapse refers to the recurrence of the symptoms of CDI within two months of the last
infection and symptom-free period – occurs in about 30% of cases
 If diarrhea recurs – place patient on Contact Precautions immediately
3.11
Treatment
 Use physician pre-printed orders for Clostridium difficile Treatment.
http://inet.interiorhealth.ca/infoResources/forms/Documents/829517.pdf
3.12
Surveillance
 Surveillance for healthcare associated CDI is carried out as per guidelines under 4.2 of ,
IV0200 DEFINITIONS FOR HEALTHCARE ASSOCIATED INFECTIONS (HAI)

Best Practice Checklist for Management of CDI available to use when increasing
rates of CDI identified in specific units/facilities
3.13
Internal Alert
 When the number of CDI cases in a unit or facility is above the pre-determined threshold
(trigger point) or there is suspected transmission, then actions can be taken to prevent
an outbreak
 Internal alert levels are determined and monitored by the IPAC epidemiologist and team
 When an ‘internal alert’ has been reached, staff within the facility are alerted to the
situation and enhanced control measures implemented
 Facility administration should work with the unit staff and IPAC to put additional control
measures and resources in place
 An internal alert is for the operational purposes of that facility and a public
announcement is not required
3.14
Outbreak Management Team
 An Outbreak Management Team (OMT) is called together and works collaboratively in
the prevention, early detection and management of outbreaks
 Under the Public Health Act, consultation is required with the Medical Health Officer
(MHO) or designate for the management of outbreaks by IPAC and the facility
Administrator – Medical Microbiologist is point of contact for acute facilities
 Public notification of the outbreak is required and posted on the Interior Health public
website
 Implement control measures including outbreak signage, additional ABHR products with
instructions on hand hygiene for staff and patients, limit visitors, additional environmental
cleaning using a sporicidal disinfectant for all inpatient rooms and bathrooms on affected
units that continue to have a high incidence of CDI cases – continue this approach until
the incidence decreases
 The OMT advocates for enhanced resources required to implement control measures
 If new cases of CDI continue to be detected, the OMT may consider recommending the
closure of the affected units to admissions until the outbreak is controlled
 Outbreak declared over when the number of cases has returned to the endemic level
 Hold a debriefing session to identify lessons learned and how future outbreaks can be
prevented – the OMT to summarize outcome and lessons learned to share with
local/regional IPAC committees
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 5
4.0
REFERENCES
4.1
ANNEX C Testing, Surveillance and Management to Clostridium difficile In All Health
Care Settings. Provincial Infectious Diseases Advisory Committee (PIDAC), Ontario; 2013.
4.2
Best Practice for Environmental Cleaning for Prevention and Control of Infections in
nd
all Healthcare Settings. 2 Edition. Provincial Infectious Diseases Advisory Committee
(PIDAC), Ontario; May 2012.
4.3
Clostridium difficile Infection (CDI) Toolkit. Provincial Infection Control Network of BC;
2013.
4.4
Fact Sheet Clostridium difficile. Public Health Agency of Canada; 2014.
4.5
A Review of C. difficile Control Measures….. Dr. Michael Gardam, Director of Infection
Prevention & Control, University Health Network and Women’s College Hospital, Toronto,
Ontario; February 2012.
See the RESIDENTIAL CARE
PLAN – Resident with Clostridium
difficile Associated Diarrhea
See the ACUTE CARE PLAN –
Acute care plan for Clostridium
difficile Associated Diarrhea
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 6
Contact Plus Precautions – Form #807914
Note: in this document the term “patient” is inclusive of patient, resident or client.
Residential Care Plan for Clostridium difficile Infection

RESIDENT
CONCERN
C-difficile
Infection
GOAL
INTERVENTION
Control spread 1.
of C-difficile
In addition to Routine Practices, use Contact Plus Precautions:

Dedicate toilet or commode at the onset of diarrhea

Empty contents of commode in Dirty Service Room in waste disposal unit
Mobility: If the resident has uncontrolled diarrhea, keep them in their room until the
symptoms are resolved or can be easily contained with personal hygiene products.
2.
Resident and Visitor Teaching:

Assist residents with hand hygiene – to be done prior to leaving their room,
after using the toilet, prior to eating/handling food and when soiled.

Remind visitors of hand hygiene and not to use resident’s bathroom
Contact Precautions can be discontinued when resident has no diarrhea for 72 hours.
Signage regarding C-difficile infection may be required. Contact Plus Precautions sign
Ensure
Resident
1.
Housekeeping needs to be informed to ensure twice daily cleaning is performed.
Confidentiality 2.
Upon transfer, notify receiving sites that Contact Precautions are required.

Environmental
Cleaning
Reduce
1.
Use a sporicidal product (accelerated hydrogen peroxide 4.5%) for cleaning and
transmission of
disinfection of resident room.
C-difficile
Clean occurs twice daily, the second cleaning and disinfection is 6-8 hours after the first
cleaning and disinfection and focuses on the high touch areas in the resident
room/area/space and bathroom.
Housekeeping will do additional precautions discharge clean of the room when Contact
Precautions are discontinued.

Persistent or
recurrent
diarrhea
Prevent
recurring
infection
1.
2.
Clostridium difficile preprinted orders available for physician use.
Observe and report progression or recurrence of symptoms.
Use Bristol Stool chart - Form #809505 to monitor diarrhea.
Note: in this document the term “patient” is inclusive of patient, resident or client.
COMMENTS – Date &
Signature
Add pertinent interventions
(i.e.) decisions regarding a
designated toilet
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 8
Acute Care Plan for Patients with Clostridium difficile Infection

Patient
CONCERN
C-difficile
associated
infection
GOAL
INTERVENTION
Control spread 1.
of C-difficile
2.
3.
In addition to Routine Practice, use Contact Plus Precautions
o private room with dedicated toilet/commode
o empty contents of commode in Dirty Service Room in waste disposal
unit
Mobility: The patient should remain in his/her own room unless going to the operating
room, attending a medical treatment session, or requiring diagnostic tests.
Patient and Visitor Teaching:
Assist patient with hand hygiene – to be done prior to leaving their room, after
using toilet, prior to eating/handling food & when soiled.

Remind visitors of hand hygiene and not to use patient’s bathroom.

Contact Plus Precautions can be discontinued when patient has no diarrhea for 72 hours.
Ensure Patient 1.
Confidentiality 2.
Post the Contact Plus Precautions sign on outside the patient’s door.
When patient goes to another department, or is transferred to another facility, the
receiving department or facility MUST be notified of need for Contact Precautions.
Note: in this document the term “patient” is inclusive of patient, resident or client.
COMMENTS
Infection Prevention and Control
Section 08S – IS0200 (Clostridium difficile)
Page 9

Environmental
Cleaning
Reduce
transmission of
C-difficile
Use a sporicidal product (accelerated hydrogen peroxide 4.5%) for cleaning and
disinfection of resident room.
Clean occurs twice daily, the second cleaning and disinfection is 6-8 hours after the first
cleaning and disinfection and focuses on the high touch areas in the patient
room/area/space and bathroom.
Housekeeping will do additional precautions discharge clean of the room when Contact
Precautions are discontinued.

Persistent or
recurrent
diarrhea
Prevent
recurring
infection
1.
2.
Clostridium difficile pre-printed orders available for physician use.
Observe and report progression or recurrence of symptoms.
Use Bristol Stool chart - Form #809505 to monitor diarrhea.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300 (Antibiotic Resistant Organisms)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0300:
Antibiotic Resistant Organisms
(ARO)
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
February 2015, July 2015, June 2016
REVIEWED DATE:
1. PURPOSE
To prevent transmission of Antibiotic Resistant Organisms (AROs) in healthcare facilities including
hospital, residential care homes and community settings.
2.
DEFINITION
Antibiotic Resistant Organism (ARO) – microorganisms that have developed resistance to the
action of several antimicrobial agents and that is of special clinical or epidemiological significance.
This guideline will refer primarily to MRSA, VRE, ESBLs and CPOs.
Cohorting – the practice of grouping patients (infected or colonized) with the same ARO together, to
confine their care to one area.
Colonization – the presence of microorganisms in or on a host with growth and multiplication but
without tissue invasion or cellular injury. With most microorganisms, colonization is far more frequent
than clinical disease. The patient will be asymptomatic. MRSA colonization may occur in the nose,
perineum, decubitus ulcers, sputum, urine and at sites of invasive devices such as feeding tubes and
tracheostomies. VRE colonization occurs primarily in the feces.
Contact – an individual who is exposed to a person, colonized or infected, with an ARO in a manner
that allows potential transmission to occur, i.e. roommate.
CPO – Carbapenemase-Producing Organisms refers to bacteria such as Klebsiella, Escherichia coli
(E. coli), Acinetobacter, and Pseudomonas that are found in normal human intestines. In some parts
of the world these groups of bacteria have acquired genes that make them resistant to a broad
spectrum of antibiotics including those known as carbapenem antibiotics. Sometimes these bacteria
can spread outside the gut and cause serious infections, such as urinary tract infections, bloodstream
infections, wound infections, and pneumonia.
Decolonization – the use of topical and systemic antimicrobials to eradicate colonization of resistant
bacteria. Current evidence does not recommend MRSA decolonization therapy as this may promote
antibiotic resistance, long-term efficacy is poor and systematic therapy may lead to adverse events.
Enterococci – bacteria normally found in the gastrointestinal tract of 95% of healthy people.
Enterococci may contaminate open wounds and, occasionally, are capable of causing invasive
disease, particularly in severely immunocompromised people.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300 (Antibiotic Resistant Organisms)
Page 2
ESBL – Extended Spectrum Beta Lactamase producing organisms – a group of Gram-negative
bacteria (predominantly bowel organisms) such as E.coli and Klebsiella, that produce enzymes that
break down antibiotics, rendering them useless. Significant infections include urinary tract infections
and surgical wound infections.
Infection – when sufficient cellular and tissue changes occur to produce overt signs and symptoms,
the individual has clinical disease. Depending on the microorganism and health status of the host,
this disease may range from mild to severe. Clinical manifestations of local or systemic infection can
include fever, increased white blood cell count, purulence, inflammation, redness, heat, swelling,
and/or pain.
MRSA - Methicillin Resistant Staphylococcus aureus – strains of Staphylococus aureus that are
resistant to oxacillin (cloxacillin). Most people with MRSA are colonized. High risk groups in the
community include injection drug users, homeless persons, chronically ill persons, individuals taking
frequent or prolonged courses of antibiotics and individuals who are in hospital for longer than 48
hours.
Outbreak Management Team – multidisciplinary team including Infection Prevention & Control,
Occupational Health, Administration, Nursing, Medical Staff, Support Services; may include Medical
Health Officer (MHO).
Point prevalence screening – the collection of specimens on all patients at a single point in time, to
determine the total number of cases and evidence of ongoing transmission of a particular
microorganism.
Screening – a process to identify patients at risk for being colonized with MRSA and/or CPO and
subsequently, obtaining appropriate specimens and ensuring Additional Precautions are
implemented.
Staphylococcus aureus (S. aureus) – a bacteria normally found in the nose and on the skin of 25 35% of healthy people. It can cause infections such as impetigo, boils, abscesses, wound infections
or invasive disease such as pneumonia.
VRE - Vancomycin Resistant Enterococcus – enterococci that have acquired resistance to
vancomycin. Most people with VRE are colonized. There is no evidence that infection with VRE is
associated with greater mortality than infection with vancomycin sensitive enterococci.
3. GUIDING PRINCIPLES
3.1
Due to the limited number of single rooms available in acute care use the Algorithm for
IPAC Private Room Allocation in Acute Care Facilities to determine priority for the single
room assignments. (NOT AVAILABLE TO NON IH FACILITIES)
3.2
How are AROs Spread?
Note
The single most common mode of transmission for AROs in a health care
setting is on the hands of health care workers who acquire it from contact with
colonized or infected patients, OR after handling contaminated surfaces or
equipment.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300 (Antibiotic Resistant Organisms)
Page 3
4.0
3.3
An ARO Alert is entered into the patient’s electronic record by the Infection Control
Practitioner when required. Alerts must protect the confidentiality of the patient.
3.4
The ARO status of a patient should not affect the decision about accepting the individual in
transfer from another healthcare setting or department and a negative specimen is not
required to transfer a patient.
3.5
In high risk areas of acute care such as ICUs, burn units, transplantation units or
cardiothoracic units any patients potentially exposed to a known MRSA or CPO positive
patient should have screening cultures performed. However, in other situations screening of
contacts may not be practicable as there are limited possibilities to intervene based upon
results.
3.6
An outbreak of an ARO occurs when there is an increase in the rate of healthcare associated
cases (infected and colonized) over the baseline rate, or a clustering of healthcare
associated cases due to the transmission of a specific microbial strain(s) in a healthcare
setting. Infection Control would call together a multidisciplinary Outbreak Management Team
to review the situation and provide guidance and support in regards to appropriate control
measures to implement.
PROCEDURE
4.1
Acute Care Admission Screening for MRSA and CPO
 All patients being admitted to acute care for 24 hours or more require screening. Follow
procedure outlined on patient Admission History forms. Use the Acute Care Admission
Screening for MRSA and CPO tool for pre-surgical screening, for surgical patients with
an unplanned admission and for patient transfers between acute care facilities
Screening must be completed within 24 hours of admission
 All patients who have been hospitalized anywhere for more than 48 hours within the last
3 months require swabs for MRSA screening:
o Nose (1 swab both nares)
o Groin (1 swab both sides)
o One swab of any open wound
 All patients require a rectal swab for CPO screening if they answer ‘yes’ to any of the
following:
o Has the patient ever had a CPO?
o Has the patient had an overnight stay in a hospital or undergone a
medical/surgical procedure outside Canada within the past 12 months?
o Has the patient had dialysis outside Canada within the past 12 months?
o Has the patient had close contact with a known CPO patient within the past 12
months? (close contact defined as household member or roommate in hospital)
o Has the patient been transferred from a facility with known, active CPO
transmission?
o Any patient requiring CPO screening swabs must be placed on Contact
Precautions in a single room
o There are different types of CPOs, so patients who are known to be CPO
positive must be rescreened for each hospital admission
4.2
A PCRA (point of care risk assessment) for every patient interaction needs to be done to
help determine room placement and necessary personal protective equipment.
4.3
Hand Hygiene
 Perform hand hygiene as per IF0200 (Hand Hygiene Guideline)
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300 (Antibiotic Resistant Organisms)
Page 4
4.4
Patient Placement and accommodation – PRIVATE ROOM ALGORITHM
 All known ARO positive patients to be placed on Contact Precautions
 Single room with toilet, patient sink and hand washing sink preferred especially for ARO
patients with diarrhea or large uncontained draining wounds
o Door may remain open
o Contact Precautions signage placed at the entrance to the patient room, cubicle
or designated bed space including Emergency Department


4.5
Cohort
o Cohort patients who are infected or colonized with the same microorganism and
are suitable roommates
o Contact your ICP regarding appropriateness of cohorting
Shared Room
o Maintain spatial separation of at least 2 metres between patients
o Roommates should be selected based on their ability to comply with precautions
o Roommates should not be at high risk for serious disease if transmission occurs
o A patient with diarrhea should not share a toilet with another patient
Patient Flow / Transport
 Communication of Additional Precautions is essential when a patient goes to another
department for testing, to another unit or to other healthcare settings/facilities. This
communication must include Emergency Medical Services (EMS) staff and other
transport staff
 Personal protective equipment should be removed and disposed of and hand hygiene
performed, prior to transporting patients
 Health care provider to wear gloves and gown for direct contact with patient during
transport
Remind patients to adhere to the 4 C’s when outside of their room.
4 C’s





4.6
Clean Hands: do hand hygiene.
Clean Clothes: wear a clean gown or clothes.
Contained wounds/body fluids: wounds covered with clean
dressing. Urine/feces and other body fluids contained.
Co-operative: able to follow instructions.
Patients are not to wear gloves and/or an isolation gown when outside the room.
Patients should not use common areas of the hospital such as the
cafeteria or lounge and should not enter other patient rooms
Personal Protective Equipment
 Personal protective equipment should be available either directly outside the patient
room, cubicle or designated bed space
 Wear gloves and gown when in direct contact with patient or patient environment
 Remove gown and gloves and discard before leaving the room or bed space and
do hand hygiene
 The same personal protective equipment should not be worn for more than one
patient
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300 (Antibiotic Resistant Organisms)
Page 5
4.7
Cleaning and disinfection of non-critical patient care equipment

Dedicate equipment to a single patient (e.g. blood pressure cuff, commodes etc.)

If equipment must be shared it must be cleaned and disinfected between patients

Do not take extra supplies into patient’s room

Do not take patient chart into the room
 Clean and disinfect equipment used for transport after each use
4.8
Cleaning of patient environment
 When precautions are discontinued or the patient is moved, do an additional
precautions discharge clean of the room/bed space and bathroom which includes
changing privacy curtains and cleaning and disinfecting or changing string/cloth call bells
or light cords
4.9
Waste, laundry and dishes
 Use Routine Practices
4.10
Education of patients, families and visitors
 Educate as per Contact Precautions signage
 Recommend to visit only one patient
 Visitors to wear gloves and gown if participating in direct patient care
 Visitors to remove gloves and gown and perform hand hygiene prior to leaving room
 Provide the appropriate ARO patient information pamphlet to the patient and family
available on the INFECTION PREVENTION & CONTROL WEBSITE. (NOT AVAILABLE TO NON IH
FACILITIES)
4.11
Surgical Settings (OR, PAR, DCS)
 REFER TO SURGICAL SERVICES PRACTICE M ANUAL. (NOT AVAILABLE TO NON IH FACILITIES)
 Pre-surgical screening is done as an outpatient and includes screening for AROs)
4.12
Emergency, Ambulatory Care and Outpatient Settings
 For all outpatients and diagnostic areas, additional ARO screening is not required
 Instruct patients to clean their hands upon entering and leaving the outpatient setting
 Clean and disinfect shared equipment between patients
 Use routine practice for cleaning environment
 If environment is visibly soiled, do an additional precautions discharge clean of the
room/bed space and bathroom which includes changing privacy curtains and cleaning
and disinfecting or changing string/cloth call bells or light cords
4.13
Maternity/Newborn Nursery
 All babies admitted to the Nursery from another hospital are screened for MRSA and
CPO and placed on Contact Precautions; if swab results are negative Contact
Precautions are discontinued.
 ARO positive mom must be placed on Contact Precautions:
o Newborn must be placed on Contact Precautions in the Nursery if newborn is not
rooming in with their mother
o Newborn does not require screening unless admitted from another hospital.
4.14
Dialysis Settings
 Screening (including swabs taken) for MRSA and CPO should be done using the Acute
Care Admission Screening for MRSA & CPO screening tool, Form #807910:
o On initial admission to any hemodialysis facility (NOTE: If an in-patient, confirm
that screening swabs for MRSA and CPO were performed during their in-patient
stay)
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300 (Antibiotic Resistant Organisms)
Page 6
o



Upon returning from an admission to an acute care hospital outside of Canada
or having had hemodialysis outside of Canada
o If requested (patients traveling to other health care centers outside of IH may
require screening swabs)
Visiting dialysis patients to have screening swabs done by their home unit, prior to their
arrival to the visiting dialysis unit
Admission to any hemodialysis unit should not be denied on the basis of ARO status
Contact Precautions need to be implemented for ARO positive patients and can be done
at the bedside. However, a private room is preferred for patients with uncontained
draining wounds or uncontrolled diarrhea and for CPO positive patients
4.15
Mental Health – including inpatient Psychiatry
 Admission screening for AROs is not required
 A Point of Care Risk Assessment (PCRA) should be done to determine if Additional
Precautions are required
 Restrict activities if wound drainage or diarrhea cannot be contained
 Follow the 4 C’s as in box above
4.16
Residential Care
 A residential care facility is the resident’s “home” and infection control precautions must
be balanced with promoting an optimal, healthy lifestyle for the residents. Studies
indicate that residents who are colonized or infected with AROs do not endanger the
health of staff or other residents, particularly when healthcare providers consistently use
Routine Practices when providing ALL care in these settings
 Screening for AROs is not a recommended practice in Residential Care in BC
 A Point of Care Risk Assessment (PCRA) should be done to determine if Contact
Precautions are required – signage is available
 Restrict activities if wound drainage or diarrhea cannot be contained
 Follow the 4 C’s as in box above
 See the RESIDENTIAL ARO CARE PLAN
4.17
Community Care
 Home and Community Care Programs must balance infection control precautions with
promoting an optimal, healthy lifestyle for the client, particularly in view of the fact that
colonization or infection with an ARO may persist indefinitely. Experience to date does
not indicate that clients who are colonized or infected with these microorganisms pose a
health risk to healthcare providers, or to other household contacts, particularly when
healthcare providers consistently use Routine Practices when providing ALL care in
these settings
Hand hygiene and cleaning and disinfection of shared equipment are the most
important ways to reduce risk of transmission of any AROs

ARO positive persons should not be denied admission to Community Care programs.
In addition to Routine Practice:
Symptomatic clients in the home should be advised to:
o Stay away from others, in a separate room, if available
o Use a designated bathroom, whenever possible
o Clean the bathroom frequently, especially frequently touched surfaces
o Not share towels or other personal items
o Stay home until symptoms resolved
o If medical appointment necessary – advise of symptoms
o See the COMMUNITY ARO CARE PLAN
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300 (Antibiotic Resistant Organisms)
Page 7
4.18
5.0
Outbreak Management
 Take surveillance specimens from all patients that are contacts (i.e. roommates) of the
source patient as well as others who were in close geographic proximity to the source
patient
 For MRSA, consider screening staff contacts if the outbreak is due to the same strain of
MRSA and new cases are identified despite precautions
 Specimens for detection of MRSA should include nasal swab, groin swab (perianal
preferred) and swab(s) from skin lesions, wounds, incisions, ulcers, exit sites of
indwelling devices; for newborn infants, a swab from the umbilicus should also be taken
 Consider conducting a prevalence screen/surveillance on the affected floor/unit if
additional cases are found after doing contact tracing, particularly if these cases have the
same strain as the source patient
 Continue prevalence screening on a regular basis (e.g. weekly) until at least two
consecutive screens are negative
REFERENCES
5.1
Routine Practices and Additional Precautions for Preventing the Transmission of
Infection in Health Care Settings; Public Health Agency of Canada; 2013.
5.2
Best Practices for Infection Prevention and Control in Perinatology In All Health Care
Settings that Provide Obstetrical and Newborn Care; Provincial Infectious Diseases
Advisory Committee (PIDAC), Ontario; April, 2012.
5.3
Annex A: Screening, Testing and Surveillance for Antibiotic Resistant Organisms
(AROs) in All Health Care Settings. Provincial Infectious Diseases Advisory Committee
(PIDAC), Ontario; February, 2013.
5.4
Antibiotic Resistant Organisms Prevention and Control Guidelines For Healthcare
Facilities. Provincial Infection Control Network (PICNet) BC; March 2013.
5.5
Routine Practices and Additional Precautions Assessment and Educational Tools.
Public Health Agency of Canada; 2013.
Note: in this document the term “patient” is inclusive of patient, resident or client.
ACUTE CARE PLAN FOR AROs (Antibiotic Resistant Organisms)
PATIENT CONCERN
Colonization:
GOAL
INTERVENTION
Control spread of
ARO
1. In addition to Routine Practice, initiate Contact Precautions
2. Always do a Point of Care Risk Assessment for every patient interaction to determine
any additional precautions that need to be taken
3. 4 C’s should be adhered to if patient is leaving room:
 Clean Hands: Wash hands for at least 15 seconds with soap and water or alcohol
based hand rub (ABHR).
 Clean Clothes: wear clean patient gown or clean clothes.
 Contain wounds/body fluids: wounds covered with clean, dry dressing. Urine/feces
and other body fluids contained.
 Co-operative: able to follow instructions.
4. Patient and Visitor Teaching: use ARO Information pamphlets
 Ensure compliance with proper hand hygiene.
 Teach visitors re: hand washing as above and use of appropriate PPE.
 Visitors are not required to wear PPE unless participating in direct patient care.
 Visitors and patients who leave the patient’s room are asked to not use the kitchen,
lounges or other facilities in the hospital.
5. Safety: Compliance with hand hygiene requires continuous reinforcement!
 Equipment that is not dedicated to resident use must be cleaned and disinfected
between uses.
6. Documentation: Each shift, check off on the patient record that the appropriate care
plan has been followed and Infection Control Recommendations remain in place.
1. Signage regarding Contact Precautions is required outside patient’s room.
2. Information about the patient’s ARO status is to remain confidential among direct care
providers (i.e. housekeeping and dietary staff only need to know type of precautions,
not patient condition).
3. When patient goes to another department, or is transferred to another facility, the
receiving department or facility MUST be notified of ARO status.
 MRSA
 ESBL
 Other
Ensure Patient
Confidentiality
ARO Infection
Stabilize
condition and
eradicate
infection
Effective Date: September 2006
1. Physician to coordinate antibiotic regime if required.
2. In addition to Contact Precautions, contact the ICP to determine necessary additional
activity restrictions and/or care interventions.
3. Patients presenting with respiratory symptoms who have an ARO identified in their
sputum must be placed on Droplet/Contact Precautions.
Revised Date: Feb 2011 / Feb 2015
Note: in this document the term “patient” is inclusive of patient, resident or client.
COMMENTS – Date
& Signature
RESIDENTIAL CARE PLAN FOR AROs (Antibiotic Resistant Organisms)
RESIDENT
CONCERN
Infection:
GOAL
INTERVENTION
Control spread
of ARO
1. In addition to Routine Practices, use Contact Precautions
 Always do a Point of Care Risk Assessment for every resident interaction to
determine any additional precautions that need to be taken.
 Room placement may need to be reviewed with ICP.
 WOUND: Cover open wounds with dressing or clothing when resident is in close
contact with other residents.
 SPUTUM: If possible, residents with symptoms of respiratory infection should be
kept in their rooms until symptoms resolve.
2. Mobility: The resident is not restricted from common living areas, dining facilities or
recreational and socializing activities unless the resident has diarrhea, pneumonia or
copiously draining wounds. Any restrictions are only in place until the symptoms
resolve. The 4 C’s should be adhered:
 Clean Hands: Wash hands for 15 seconds with soap and water or use alcohol
based hand rub (ABHR).
 Clean Clothes: wear clean clothes every day.
 Contain wounds/body fluids: wounds covered with clean, dry dressing. Urine/feces
and other body fluids contained.
 Co-operative: able to follow instructions.
3. Resident and Visitor Teaching: use ARO Information pamphlets
 Assist with hand washing & appropriate use of ABHR – to be done prior to leaving
their room, after using the toilet, prior to eating/handling food and when soiled.
 Teach visitors re: hand hygiene as above.
4. Safety: Compliance with hand hygiene requires continuous reinforcement!
Equipment that is not dedicated to resident use must be cleaned and disinfected
between uses.
 MRSA
 ESBL
 Other
Site:
 Wound
 Sputum
Ensure
Resident
Confidentiality
1. Signage for Contact Precautions available if required.
2. Information about the resident’s ARO status is to remain confidential among direct
care providers.
3. Upon transfer, notify receiving sites and transfer personnel of ARO status – teach
resident and visitors about additional precautions taken at acute care sites (Contact
Precautions, single room, etc.).
EFFECTIVE DATE: September 2006
REVISED DATE: Feb 2011 / Feb 2015
COMMUNITY CARE PLAN FOR AROs (Antibiotic Resistant Organisms)
Note: in this document the term “patient” is inclusive of patient, resident or client.
COMMENTS – Date &
Signature
Add pertinent interventions (i.e.
decisions regarding a
designated toilet) and highlight
areas under intervention that
apply to resident
CLIENT CONCERN
Infection:
GOAL
Control spread of
ARO
INTERVENTION
1. In addition to Routine Practices, use Contact Precautions
 Always do a Point of Care Risk Assessment for every client interaction to
determine any additional precautions that need to be taken.
 WOUND: Cover open wounds with dressing or clothing.
 URINE or STOOL: If possible, client should have separate toilet. Empty urinary
catheter contents in designated toilet. When separate toilet not available, the
shared toilet requires routine cleaning with a household disinfectant.
 SPUTUM: If possible, clients with symptoms of respiratory infection should be
requested to stay at home until symptoms resolve.
2. Mobility: The client is not restricted in home or public unless there is an uncontained
draining wound – public pools and contact sports or other skin to skin contact should
be avoided until the wound is healed. Client should notify any medical personnel of
MRSA status prior to appointments. Teach client to follow the 4 C’s:
 Clean Hands: Wash hands for 15 s with soap and water or alcohol based hand rub
(ABHR) often while at home and in the community.
 Clean Clothes: wear clean clothes every day and practice good personal hygiene.
 Contain wounds/body fluids: wounds covered with clean, dry dressing or clothing;
urine/feces and other body fluids container.
 Co-operative: able to follow instructions.
3. Client & Family Teaching: use ARO Information pamphlets
1. Assist with hand washing with plain soap – to be done prior to leaving their home,
after using the toilet, prior to eating/handling food and when are visibly soiled.

Remind visitors to practice good hand hygiene.
4. Safety: Compliance with hand hygiene requires continuous reinforcement!
COMMENTS
Add pertinent interventions to
CHW care plan; i.e. decisions
regarding a designated toilet
and clothing over open wounds
will need to be included in the
CHW care plan
Ensure Client
Confidentiality
1. Signage regarding ARO status is NOT required.
2. Information about the client’s ARO status is to remain confidential among direct care
providers.
3. Notify acute or residential site of ARO status upon transfers – teach client and visitors
regarding additional precautions taken at acute care sites (Contact Precautions, single
room, etc.).
To ensure client confidentiality,
DO NOT write the ARO status
on the CHW care plan.
 MRSA
 ESBL
 Other
Site:
 Wound
 Stool
 Urine
 Sputum
EFFECTIVE DATE: September 2006
REVISED DATE: Nov 2010 / Feb 2015
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300S (Carbapenemase Producing Organisms (CPOs)
Page 11
Acute Care Admission Screening for
MRSA and CPO
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300A (Carbapenemase Producing Organisms (CPOs)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0300A Carbapenemase Producing
Organisms (CPOs)
1.0
EFFECTIVE DATE: July 2015
REVISED DATE:
REVIEWED DATE:
PURPOSE
To prevent transmission of CPOs (Carbapenemase Producing Organisms) in hospitals, residential
care homes and community settings.
2.0
DEFINITIONS
CPO – Carbapenemase-Producing Organism refers to bacteria that are resistant to carbapenems – a
class of antibiotic usually reserved to treat serious infections. These resistant bacteria produce an
enzyme (carbapenemase) that breaks down the structure of the carbapenem antibiotics, making
infections very difficult to treat. CPOs can arise through the acquisition of carbapenemase genes
from other bacteria. Some examples of these genes are the New-Delhi Metallo-β-lactamase (NDM)
and Klebsiella pneumonia carbapenemase (KPC).
Many people with a CPO harbor the bacteria without causing symptoms (colonization). Others may
have an infection in their bloodstream, urinary tract or surgical site, with very limited antibiotic
treatment options and poor clinical outcomes. In Canada, most CPO cases have been identified in
persons who have been hospitalized and/or had a medical procedure done in countries outside of
Canada.
CPOs are usually spread person-to-person through contact with infected or colonized people, or
contaminated surfaces or medical equipment. Good hand hygiene by healthcare workers, patients,
and visitors and careful cleaning and disinfection of rooms and equipment, can help prevent the
spread of CPOs.
Colonization – the presence of microorganisms in or on an individual with growth and multiplication
but without tissue invasion or cellular injury. With most microorganisms, colonization is far more
common than clinical disease.
Contact – an individual who is exposed to a person, colonized or infected, with a CPO in a manner
that allows potential transmission to occur (i.e.) roommate.
Infection – when sufficient cellular and tissue changes occur to produce overt signs and symptoms,
an individual has clinical disease. Depending on the microorganism and health status of the host this
disease may range from mild to severe. Clinical manifestations of local or systemic infection can
include fever, increased white blood cell count, purulence, inflammation, redness, heat, swelling,
and/or pain.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300A (Carbapenemase Producing Organisms (CPOs)
Page 2
Internal Alert – when the number of CPO cases in a unit or facility is above the pre-determined
threshold (trigger point) or there is suspected transmission. Internal alerts bring increased staff
awareness of CPO cases in the unit/facility so actions can be taken to prevent an outbreak.
Outbreak Definition – CPO cases are classified as an outbreak when the number of new, timerelated, healthcare associated CPO cases in a unit or facility is above the expected threshold for that
unit or facility and where there is evidence of ongoing transmission despite appropriate interventions.
Molecular confirmation of CPO genes in patient’s isolates is required to determine ongoing
transmission. Declaring an outbreak must be done in conjunction with the facility Outbreak
Management Team.
Outbreak Management Team – at a minimum, includes the site Infection Control Practitioner,
Infection Prevention and Control (IPAC) director, Medical Microbiologist, epidemiologist, site
administrator, site medical director, nursing unit manager and housekeeping supervisor.
Screening – a process to identify patients at risk for being colonized with CPO, obtaining specimens
for CPO identification and ensuring Additional Precautions are implemented.
3.0
GUIDING PRINCIPLES
3.1
Anyone being screened for CPO must be placed on Contact Precautions in a single room
while awaiting screening results. If the PCRA (point of care risk assessment) identifies
respiratory symptoms, use Droplet Contact Precautions.
3.2
How Are CPOs Spread?
Note
4.0
3.3
An ARO Alert is entered into the patient’s electronic record by the Infection Control
Practitioner.
3.4
Any patients potentially exposed to a known CPO positive patient should have a screening
test (rectal swab; stool if rectal swab not available) performed.
3.5
The CPO status of a patient should not prevent transfer of the individual within a facility or to
another facility.
PROCEDURE
4.1
Acute Care Admission Screening for CPO
All patients being admitted to acute care for 24 hours or more require screening. Follow
procedure outlined on patient Admission History forms. Use the Acute Care Admission
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300A (Carbapenemase Producing Organisms (CPOs)
Page 3
Screening for MRSA and CPO tool for pre-surgical screening, for surgical patients with an
unplanned admission and for patient transfers between acute care facilities.
Patients require a rectal swab (stool if rectal swab not available) for CPO screening if they
answer ‘yes’ to any of the following:
 Has the patient ever had a CPO?
 Has the patient been outside of Canada and had an overnight stay in a hospital or
undergone a medical/surgical procedure within the past 12 months?
 Has the patient had dialysis outside Canada within the past 12 months?
 Has the patient had close contact with a known CPO patient within the past 12
months? (close contact defined as household member or roommate in hospital)
 Has the patient been transferred from a facility with known, active CPO
transmission?
 There are different types of CPOs, so patients who are known to be CPO positive
must be retested for each hospital admission.
Please Note: For negative screening results, there will be a comment on the lab
result that states ‘Continue Contact Precautions as patient has had a previous
positive CPO result’.
Any patient requiring CPO screening swabs must be placed on Contact Precautions in
a single room. Precautions may be discontinued if the screening swab is negative and the
patient was not previously CPO positive.
4.2
Patients who have a CPO identified in a clinical specimen must be placed on Contact
Precautions for the duration of their hospitalization. Use Droplet Contact Precautions if a
CPO is identified in a sputum culture.
4.3
Hand Hygiene
Perform hand hygiene as per IF0200 (Hand Hygiene Guidelines in IPAC Manual).
4.4
Patient Placement and Accommodation
Place patient in a single room on Contact Precautions until discharge
 Door may remain open
 Additional precautions signage placed at the entrance to the patient room, cubicle or
designated bed space (i.e.) Emergency Department
4.5
Patient Flow/Transport
 Transfers and/or bed moves should be avoided unless clinically necessary
 Communication of additional precautions is essential when a patient goes to another
department for testing, to another unit or to other healthcare settings/facilities including
Emergency Medical Services (EMS) and other transport staff.
 Healthcare provider to remove PPE and do hand hygiene prior to transporting patients.
 If direct contact with patient is required during transport, then those staff must don PPE.
4.6
Personal Protective Equipment (PPE)
 PPE to be available directly outside the patient room, cubicle or designated bed space.
 Wear gloves and gown when in direct contact with patient or patient environment.
 Remove gown and gloves and discard before leaving the room or bed space and do
hand hygiene
4.7
Patient Care Equipment
 Dedicate equipment to a single patient (e.g. blood pressure cuff, commodes etc.).
• If equipment must be shared it must be cleaned and disinfected between patients.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300A (Carbapenemase Producing Organisms (CPOs)
Page 4
• Do not take extra supplies into patient’s room.
• Do not take patient chart into the room.
• Clean and disinfect equipment used for transport after each use.
4.8
Cleaning of Patient Environment
 Patient room to be cleaned daily and frequently touched surfaces to be cleaned twice
daily using regular hospital disinfectant – housekeeping to be notified by nursing staff
(Appendix 1: Enhanced Cleaning Checklist)
 Do an additional precautions discharge clean of the room/bed space and bathroom
which includes changing privacy curtains and cleaning and disinfecting or changing
string/cloth call bells or light cords (IH Housekeeping for Healthcare manual pg.109).
4.9
Waste, Laundry, Dishes and Cutlery
 Use routine practices
4.10
Education of Patients, Families and Visitors
 Educate as per additional precautions signage.
 Provide the Screening for CPOs patient information pamphlet to the patient and family
available on the Infection Prevention & Control website
4.11
Surveillance
 For patients confirmed to be positive for a CPO, Infection Prevention and Control (IPAC)
will collaborate with unit staff and the BC Public Health Microbiology & Reference
Laboratory (BCPHMRL) to collect data required for surveillance purposes
 For positive CPO isolates, BCPHMRL will assign a unique identifier which will be
included in the laboratory report and will notify the submitting laboratory
 The submitting laboratory will work with the site ICP to ensure completion of the
surveillance form for CPO https://www.picnet.ca/wp-content/uploads/CPO-SurveillanceForm.pdf: Complete Appendix C for CPO colonization cases. Complete Appendix C and
Appendix D for CPO infected cases.
 Submit completed forms to the Provincial Infection Control Network (PICNet) and IPAC
epidemiologist
 The IPAC epidemiologist will submit denominator data to PICNet on a quarterly basis
including:
 Total number of hospital admissions per quarter
 Total number of inpatient days per quarter
 Total number of CPO cases per quarter
 PICNet and BCPHMRL will summarize the CPO data and report back to the health
authorities, the Ministry of Health and the BC Association of Medical Microbiologists
(BCAMM) quarterly.
4.12
Internal Alert
 When the number of CPO cases in a unit or facility is above the pre-determined threshold
(trigger point) or there is suspected transmission
 Triggering an internal alert does not require confirmed laboratory results and may include
patients that were known or found to be positive for a CPO on admission
 When an ‘internal alert’ has been reached, staff within the facility should be alerted to the
situation and enhanced control measures implemented
 Facility administration should work with the unit staff and IPAC to put additional control
measures and resources in place
 An internal alert is for the operational purposes of that facility and a public announcement
is not required
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300A (Carbapenemase Producing Organisms (CPOs)
Page 5
4.13
5.0
Outbreak Management Team
 An Outbreak Management Team (OMT) works collaboratively in the early detection,
declaration and management of the outbreak
 Under the Public Health Act, consultation is required with the Medical Health Officer
(MHO) or designate for the management of outbreaks by IPAC and the facility
Administrator - Medical Microbiologist is point of contact for acute facilities
 The OMT to collaborate with the BCPHMRL to facilitate rapid testing of isolates to
determine CPO gene types
 The OMT facilitates communication of the outbreak situation to receiving hospitals of all
transferred patients and informs other health authorities and PICNet
 The OMT guides decisions to limit new admissions, close units or close an entire facility
if necessary
 Decisions around contact tracing to be done in consultation with the IPAC Medical
Director or designate, including the need for CPO screening swabs (i.e.) rectal swab,
ostomy site swab
 The OMT advocates for enhanced resources required to implement control measures
 The OMT to summarize outcome and lessons learned to share with local/regional IPAC
committees
REFERENCES
5.1
Toolkit for the Management of Carbapenemase Producing Organisms (CPO)
Provincial Infection Control Network (PICNet) BC; September 2014.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0300A (Carbapenemase Producing Organisms (CPOs)
Page 6
Appendix 1
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0400 (Scabies/Lice)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0400:
Scabies/Lice
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
REVIEWED DATE: February 2015
1.0
PURPOSE
To prevent transmission of scabies and lice to patients and staff.
2.0
DEFINITIONS
Scabies
 Scabies is a contagious parasitic infestation caused by a mite, Sarcoptes scabiei.
 Scabies infestations are identified by the following characteristics:
o Skin penetration is visible as papules or vesicles.
o Linear burrows formed by the mite under the skin.
o Severe pruritus.
These lesions commonly appear in interdigital spaces, anterior surfaces of wrists and ankles, axillae,
skin folds, genitalia, belt-line and abdomen. Itching may be intense, especially at night and lesions
may become secondarily infected due to scratching.
Crusted (Norwegian ) scabies presents as a crusty, scaly dermatitis usually on hands and feet,
including dystrophic nails. Some affected individuals may have a generalized erythematous eruption.
Norwegian scabies is highly infectious owing to the large numbers of mites present.
Definitive diagnosis of scabies infestation is by microscopic examination of mites extracted by a
needle or scalpel (skin scraping).
Lice
Lice (pediculosis) are called ectoparasites because they live outside the host’s body. There are three
types of human lice which are usually, but not always, confined to a certain part of the body. They
are named according to the region of the body that they infest or their general appearance: head
louse, body louse, and pubic or crab louse. These creatures cannot fly or jump, but head and body
lice move quickly, passing rapidly from host to host.
Head Lice
Head lice generally prefer the fine hairs of the head especially around the ears and the nape of the
neck or eyebrows and eyelashes. Adult larvae and nits are visible to the naked eye:
 Adult lice are reddish-brown.
 Unhatched eggs are pearly white.
 Hatched eggs are translucent.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0400 (Scabies/Lice)
Page 2
Infectious Period
 Scabies and lice can be transmitted up until the time they are eradicated by treatment with 5%
permethrin cream.
 The incubation period for primary infestation occurs as early as 10 days, but it is typically 4 – 6
weeks.
Transmission
 Scabies and lice are transmitted through direct or indirect contact.
 Although blood and body fluids are not affected by these infestations, the patient’s clothing, bed
linen, and mattress are contaminated by direct contact with the infected patient.
 Head lice are transmitted through contact with infested hair or with articles such as brushes,
combs, headgear, or clothing of the infested person.
 Transmission of pubic lice is usually by sexual contact.
3.0
PROCEDURE
3.1
Additional Precautions
 Patients with scabies or lice are placed on Contact Precautions
 REFER TO IH0400-CONTACT PRECAUTIONS GUIDELINE until 24 hours following treatment.


3.2
In persons with crusted scabies, the length of additional precautions may be longer.
Staff to wear a gown and gloves for all patient contact until the treatment has been
completed and Contact Precautions discontinued.
Treatment
 Ordered by the attending physician.
 5% permethrin cream applied as directed. Milder doses may be required for children and
pregnant or lactating women.
Itching may persist for days to weeks following treatment. This is not to be
mistaken for treatment failure.

Carefully examine the patient for new burrows in seven days. If there is evidence of
continued infestation, treatment may be repeated if considered necessary - ordered by
the attending physician.
3.3
Staff
Contact Workplace Health and Safety if symptomatic.
3.4
Handling Patient’s Clothing, Linen And Laundry
 Place patient’s personal clothing in a plastic bag and securely close the bag. Send this
laundry home with the family to be laundered.
 Routine Practices are used for handling all laundry items – place soiled linen in
appropriate plastic laundry bag and send to Laundry for cleaning.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0400 (Scabies/Lice)
Page 3
4.0
3.5
Housekeeping
Perform routine cleaning.
REFER TO IF0100- ROUTINE PRACTICES FOR ALL CARE AREAS GUIDELINE
3.6
Management of Scabies Outbreaks
See B.C. Centre for Disease Control (BCCDC) for policy:
REFERENCES
4.1
APIC Text 2009.
4.2
BCCDC Communicable Disease Manual.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0500A:
Tuberculosis
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
REVIEWED DATE:
1.0
PURPOSE
The goal of the Tuberculosis (TB) Management Program is to prevent transmission of TB to staff
and patients.
2.0
DEFINITIONS
The most common site of TB infection is in the upper regions of the lungs. Mycobacterium
tuberculosis is spread by the airborne route when patients expectorating viable tubercle bacilli
contaminate the surrounding airspace. Aerosolized tubercule bacilli can be inhaled by
susceptible patients and staff and can lead to primary tuberculosis infection. The incubation
period for TB is between two and twelve weeks.
Pulmonary and laryngeal TB are the only types of TB that are spread via the airborne route.
In Canada, TB occurs in well-defined populations including Aboriginal Canadians, the urban poor
or immigrants from high-incidence countries in Asia, Eastern Europe, Africa and Latin America.
Immunocompromised persons such as those with HIV and diabetes are also at an increased risk
of developing active TB. Other groups at risk include people who live or work in residential care
facilities (e.g. jail, nursing homes, drug treatment centers), alcoholics, indigent persons and IV
drug users. Persons who live in the same household with a high risk individual are also at risk.
Because healthcare providers have frequent contact with persons in these groups, the risk of
transmission of TB remains an important potential occupational hazard.
3.0
GUIDING PRINCPLES
A HIGH INDEX OF SUSPICION MUST BE MAINTAINED – EARLY DIAGNOSIS IS KEY IN PREVENTING
HEALTHCARE ASSOCIATED TRANSMISSION FROM INFECTIOUS CASES WHICH OFTEN OCCURS BEFORE
DIAGNOSIS.
3.1
Determinants of TB Transmission

TB is spread by the inhalation of airborne organisms when a patient coughs,
sneezes or speaks – once infectious particles have been aerosolized, they are
spread throughout a room or building by air currents and can be inhaled by other
individuals.

Procedures associated with increased risk of generation of infectious aerosolized
particles including bronchoscopy, laboratory and autopsy procedures, cough
inducing procedures (i.e. sputum induction), administration of aerosolized
therapies that induce coughing and irrigation of TB-infected wounds.

Patients with respiratory secretions that are acid-fast bacilli (AFB) smear positive
are more infectious than those whose smear results are negative.

Patients with laryngeal involvement are particularly contagious.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 2


The risk of transmission increases with the increasing amount of time spent with
an infectious patient without wearing appropriate personal protective equipment
(PPE).
In buildings with sealed windows and mechanical ventilation systems,
recirculation of air can contribute to transmission in healthcare facilities.
3.2
Risk classification: healthcare facilities
 Classification is based on the number of active inpatient beds and the number of TB
cases of all forms and sites.
Hospital with > 200 beds:
< 6 TB patients admitted annually = low risk.
> 6 TB patients admitted annually = medium risk.
Hospital with < 200 beds AND other facilities such as long-term care:
< 3 TB patients admitted annually = low risk.
> 3 TB patients admitted annually = medium risk.
 In Medium-risk hospitals a TB management committee is recommended, whose
members should include persons with day-to-day responsibility for infection
prevention and control and employee health, representation from senior
administration, laboratory, nursing, medicine, other health disciplines (e.g. respiratory
technology) and public health (additional members may be added from support
services such as pharmacy, housekeeping, physical plant).
3.3
Risk classification: healthcare workers

High-risk activities including cough-inducing procedures (sputum induction,
pentamidine aerosol), autopsy, morbid anatomy and pathology examination,
bronchoscopy, designated mycobacteriology laboratory procedures, especially
handling cultures of M. tuberculosis.

Intermediate-risk activities including regular direct patient contact (e.g. by nursing,
respiratory, social workers, physiotherapists, housekeeping) on units to which
patients with active TB may be admitted.

Low-risk activities including minimal direct patient contact (medical records,
administration, maintenance) and those who work on units where TB patients are
unlikely to be admitted such as obstetrics or pediatrics.

IH WH&S (Workplace Health & Safety) have developed a tool and will work
collaboratively with Infection Control Practitioners to establish risk classifications –

3.4
I.H FACILITY
REFER TO THE FACILITY TUBERCULOSIS RISK
ASSESSMENT FORM
NON I.H. FACILITY
REFER TO THE FACILITY TUBERCULOSIS RISK
ASSESSMENT FORM.
Recommend that all facilities make available to their healthcare workers annual
summary information on the clinical, epidemiologic and microbiologic features of
patients whose TB is diagnosed within the hospital – will help to increase awareness
of TB in the patient population served by the hospital.
Early identification of patients with suspected TB
 Symptoms consistent with active TB include fever, cough for more than 3 weeks,
unexplained weight loss, hemoptysis, loss of appetite, and night sweats.
 Chest x-ray done in suspect cases.
 Sputum specimens tested for acid-fast bacilli (AFB) in suspect cases
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 3
o
o
4.0
Collect 3 sputum specimens 8 – 24 hours apart and at least one should be
collected in the early morning upon awakening.
Do gastric aspirates in children too young to produce sputum.
PROCEDURE
There are 6 specific processes:
 Airborne Precautions
 Environmental Engineering Controls
 Respiratory Protection
 Personal Controls: Screening and follow-up
 Contact Investigation for Patient & Staff
 Discharge Planning
4.1
Airborne Precautions
(back to PROCEDURE)
Inform Infection Prevention and Control of all patients with confirmed TB and patients
who have a high suspicion of TB who are in the facility.
 Patient must be placed on Airborne Precautions in an appropriately ventilated
Airborne Isolation Room
 REFER TO IH0200 – AIRBORNE PRECAUTIONS
GUIDELINE







If an Airborne Isolation Room is not available then arrange to have the patient
transferred to a facility with the necessary room requirements as quickly as possible.
Staff entering the room must wear approved respiratory protection (will be referred to
as N95 respirators for remainder of document), ensuring the seal checks are done
when the N95 respirator is put on.
 REFER TO IH0200 – AIRBORNE PRECAUTIONS GUIDELINE
Visitors entering the room should be offered an N95 respirator, staff to teach the seal
check and how to put the N95 respirator on. Visits by children should be discouraged
because of their increased susceptibility.
Patient is to leave the room for essential procedures only and is to wear a
surgical/procedure mask when outside their isolation room.
Exceptions due to extenuating circumstances must be reviewed and approved by the
attending physician & Infection Control – a written order is required.
Notify receiving departments of Airborne Precautions requirements – staff will need to
wear an N95 respirator when the patient is unable to wear a surgical/procedure mask.
If transport between facilities is required, patient should be transported in wellventilated vehicles (i.e. with the window open) and attendants should wear an
approved respirator mask – DO NOT use public transportation.
4.1.1

Special Situations:
ICU
o
Maintain Airborne Precautions.
o
Place patient in an Airborne Isolation Room with door closed.
o
Staff must wear N95 respirator.
o
If intubation and mechanical ventilation is required, an appropriate bacterial
filter should be placed on the endotracheal tube to prevent contamination of
the ventilator and the ambient air.
o
Use closed suction apparatus for endotracheal suctioning.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 4

Surgery
Surgery should be postponed or scheduled at the end of the day.
If intubation and mechanical ventilation is required, an appropriate
bacterial filter should be placed on the endotracheal tube to prevent
contamination of the ventilator and the ambient air.
o
Use Airborne Isolation Room (if available) for procedure.
o
Staff must wear N95 respirator.
o
Door to room patient is in must remain closed.
o
o

4.1.2
Minor procedures that are not high risk for TB transmission
o Refers to urgent procedures needed for medical care that cannot be
postponed until the patient is deemed non-infectious such as blood work or
diagnostic imaging.
o Preference is to perform procedure in room with appropriately ventilated
negative pressure with staff wearing approved N95 respirator.
o If not possible, patient should be instructed to wear a surgical/procedure
mask during procedure, recovery and transport. Patient should be instructed
to keep the mask on and change the mask if it becomes wet.
Discontinuation of Airborne Precautions for Patients with suspect TB - on
approval only by the Infection Prevention & Control Practitioner, the
Respirologist, the Infectious Diseases Physician or the Medical Director for
Infection Prevention and Control

When three successive samples of sputum are negative on smear, unless
TB is still strongly suspected, cultures are pending and no other diagnosis has
been made.

The sputum specimens should be collected 8-24 hours apart and at least one
should be an early morning specimen.

When another definitive diagnosis is made and active TB is considered
unlikely.
Note:
A single negative AFB smear from bronchoalveolar lavage (BAL) does
NOT definitively exclude active TB and three induced sputum
specimens have superior yield for the diagnosis of active TB than a
single bronchoscopy.




Patients with smear-positive TB – require three consecutive negative
sputum smears - the sputum specimens should be collected 8-24 hours apart
and at least one should be an early morning specimen AND there should be
clinical evidence of improvement AND evidence of adherence to at least 2
weeks of multidrug therapy based on the antibiotic sensitivity of the patient’s
organism.
Patients with smear-negative, culture-positive TB – discontinue Airborne
Precautions after 2 weeks of appropriate multidrug therapy as long as there is
clinical evidence of improvement.
In the event that a smear-positive, culture-negative condition develops during
treatment, Airborne Precautions may be discontinued provided three consecutive
sputum specimens are culture negative after 6 weeks of incubation.
Patients with active Multidrug resistant (MDR-TB) – must remain in
Airborne Precautions for the duration of their hospital stay or until three
consecutive sputum cultures are negative after 6 weeks of incubation; if
discharge is being planned, refer to 7.0 DISCHARGE PLANNING.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 5

4.2
Patients with pleural TB – if unable to collect sputum cultures, recommend
bronchoscopy to obtain specimens to rule out pulmonary TB – must ensure
samples are taken from various areas of effusion.
Environmental Engineering Controls
(back to PROCEDURE)
4.2.1






4.2.2
4.3
Ventilation
Newly constructed Airborne Isolation Rooms should have 12 air changes per
hour; pre-existing rooms should have at least 6 air changes per hour or as
per current CSA Standards.
The direction of air flow should be from the hall and into the room and then
exhausted outdoors.
Direction of air flow should be tested with smoke tubes at all four corners of
the door daily when the room is occupied, unless the room is equipped with
automatic pressure monitoring.
Windows and doors should be kept closed at all times.
The air changes and direction of air flow should be verified at least every 6
months AND if any changes occur such as HVAC equipment failure or alarm
failure.
Time needed to remove airborne contaminants after generation of infectious
droplet nuclei has ceased is 45 minutes.
Sputum Induction, Pentamidine Aerosol, Bronchoscopy Suites and
Autopsy Suites
 Airborne Isolation Room requires at least 12 air changes per hour or as per
current CSA Standards.
 Time needed to remove airborne contaminants after generation of infectious
droplet nuclei has ceased is 45 minutes.
Respiratory Protection Program
(back to PROCEDURE)







Current recommendations call for particulate respirator masks that filter 95% of particles
of 1 micron or larger and have less than 10% leak to protect workers against airborne
TB.
Most common product used are NIOSH-designated N95 respirators.
Healthcare providers require education regarding the occupational risk of TB, the role of
respiratory protection to reduce that risk, the importance of wearing the N95 respirator
properly, doing a seal check each time the N95 respirator is put on so that there is a tight
facial seal and ensuring the N95 respirator is put on correctly before entering the
patient’s room.
N95 respirators must be available for staff whenever a patient is identified who is
suspected of or confirmed to have active TB.
N95 respirators should be worn by workers involved in the transport of patients
suspected of or confirmed as having active TB, e.g. ambulance workers, particularly
when patient cannot wear a surgical/procedure mask.
N95 respirators should be available for caregivers, e.g. community healthcare workers
who may have to provide care while waiting for patient transfer to a facility with
appropriate environmental controls.
TB patients can wear surgical/procedure mask when they leave their rooms as these
mask are effective in trapping the large infectious particles expelled by TB patients.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 6

4.4
Visitors should be offered an N95 respirator, staff to teach the seal check and how to put
the mask on.
Personal Controls: Screening & Follow-up
(back to PROCEDURE)
4.4.1





4.4.2



4.4.3
4.5
Baseline Tuberculin Skin Testing (TST) For Healthcare Workers
Appropriate baseline TST for all potentially exposed healthcare workers in all
healthcare settings is important (BCCDC TB Control does not recommend a
two step TST).
Upon hire, all employees should have a TST unless they have documented
results of a prior positive test.
Workers with reactions of less than 10 mm induration should be considered
TST negative for baseline screening purposes.
Workers with a reaction of 10 mm induration or greater on the test should be
considered TST positive, be referred for chest radiography and medical
evaluation and consideration of prophylactic treatment of Latent TB Infection
(LTBI).
Healthcare workers with history of a positive TST should not receive further
TSTs – performing annual chest radiography of asymptomatic TST-positive
staff is not recommended (Pg. 338 Canadian TB Standards 2007).
TST Following Unprotected Exposure
Any healthcare worker who has unprotected exposure to a patient who is
confirmed to have active, contagious TB must be considered at risk of
infection.
For TST-negative workers, a TST should be done as soon as possible and, if
negative, repeated after 8 to 12 weeks. If TST conversion occurs, the
worker should be referred for chest radiography and medical evaluation.
For TST-positive workers, the worker should be educated regarding the
signs and symptoms of TB and if such symptoms develop, chest radiography
should be performed and three sputum specimens should be tested for AFB.
Periodic TST for Workers in Medium Risk Hospitals and Programs OR
Those Performing High Risk Activities in All Hospitals
 Annual TST is recommended for healthcare workers with negative baseline
TST who are involved in moderate-risk activities in medium-risk hospitals
AND for workers involved in high-risk activities in all hospitals.
Contact Investigation for Patients and Staff
(back to PROCEDURE)
(A person identified as having come in contact with a case of active disease. The degree of
contact is usually further defined on the basis of closeness. Contacts may be classified as
close, casual or community.)
 When a case of TB is identified and appropriate Airborne Precautions had not been
implemented, a large number of contacts who need to be assessed can result. This
includes patients, hospital staff, physicians, volunteers and visitors who were exposed to
the case during the infectious period.
 If the case arrived from the community or was transferred from another facility, contacts
outside the institution would also need to be considered.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 7







ICP to work collaboratively with the Communicable Disease (CD) Unit, WH&S and
medical staff to ensure appropriate contact investigation and follow up is implemented
promptly.
Patients are considered a contact if they have shared a room with another patient
confirmed with TB – they have had regular, prolonged contact with the source case and
share breathing space daily.
Patient contacts are NOT infectious and DO NOT require Airborne Precautions, however,
they do require follow up evaluation by their family physician.
ICP notifies CD Unit of positive active TB case and potential contacts in hospital – Public
Health will assist in follow up of discharged patients, visitors and volunteers.
ICP notifies WH&S regarding the contact investigation of an active case of TB – WH&S
will carryout follow up for staff exposures (Section 5.2 above).
ICP notifies the ‘contact’ patient’s attending physician regarding the potential exposure of
their patient to an active TB case and advises that follow up is necessary - if patient still
in hospital, a baseline TST can be done by the institution.
ICP notifies the Patient Transport Office (PTO) of potential external contacts such as
ambulance personnel, first responders and other transport services and advises that
follow up is necessary – PTO will ensure contact is made with the necessary providers in
this regard.
4.6
Discharge Planning
(back to PROCEDURE)
 Initially smear-positive patients may be discharged home even if they are still smear
positive provided a smooth transition plan has been developed between the hospital and
community public health for follow–through provision of TB medications and ongoing
care.
 Some TB patients may be noncompliant, homeless or have circumstances where
community care is unlikely to succeed and may need hospitalized provision of treatment
medications until they become non-infectious (sputum is smear negative) – this process
may be voluntary by the patient OR under an Order by the Medical Health Officer under
the Health Act.
 Once all parties have been notified and a discharge date has been agreed upon
(minimum of 3 working days required to ensure services are in place), the discharge
can proceed.
 Public Health is responsible for evaluating conditions necessary for the discharge to
proceed including directly observed therapy (DOT) if indicated, evaluation of household
air recirculation in housing units such as apartment complexes, review of household
contacts including infants and children, patient counseling about precautions necessary
during infectious period of disease and to refrain from going into any other indoor
environment where TB transmission could take place AND if patient has to attend an
outpatient clinic, they must wear a mask until they are no longer infectious.
4.7
Process/Protocol
 As soon as possible after an in-patient is confirmed as having active pulmonary
tuberculosis, the CD Unit will coordinate a case teleconference – this is a collaborative
process for the purpose of information sharing, identification of case contacts, early
recognition of discharge planning needs and coordination of key stakeholders, including:
o
CD Unit.
o
Hospital Transition Nurse/Discharge Planner (specific to unit where patient is
located).
o
Patient Care Coordinator [PCC] (specific to unit where patient is located).
o
Hospital Infectious Disease Pharmacist [or designate].
o
Urban Outreach Social Worker (if case in Kelowna).
o
Urban Outreach Case Manager (if case in Kelowna).
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 8
o
o
o







5.0
Public Health Nurse (specific to geographic area).
Hospital Social Worker (if patient not an Urban Outreach client).
Home & Community Care Manager [or designate] (specific to geographic
area).
o
Occupation Health Nurse Specialist.
o
Hospital Infection Control Practitioner.
o
WH&S Consultant (for fit-testing), Community Infection Control Practitioner
and others may join teleconference as needed.
Needs to be a collaborative process between the hospital physician, MHO and
consultant TB physician from BCCDC TB Control division to determine
appropriateness of discharge.
MHO will notify public health services to assure the out-patient prescription
medications are in place and that community protection protocols are established,
should the patient still be infectious.
CD Unit will coordinate with local Public Health Nursing staff and the hospital
discharge planner, to ensure an adequate discharge plan is in place prior to patient
release.
Notify family doctor for an appropriate follow-up appointment.
Notify Home/Community Care Services to prepare for receiving and attending the
patient, giving sufficient time to allow for adequate fit-testing and education of staff, if
required.
Notify transport services, if required.
Once all parties have been notified and a discharge date has been agreed upon,
(minimum of 3 working [Mon-Fri] days required to ensure services are in place additional time may be required depending on the complexity of the case), the
discharge can proceed.
REFERENCES:
5.1
Canadian Tuberculosis Standards 6th Edition by The Public Health Agency of Canada
and The Lung Association, 2007; Chapter 16.
5.2
APIC Text of Infection Control and Epidemiology 3rd Edition 2009; Chapter 91.
5.3
Canadian Standards Association CAN/CSA-Z317.2-01 Special Requirements for
Heating, Ventilation, and Air Conditioning (HVAC) Systems in Health Care Facilities 2008.
5.4
WorksafeBC Occupational Health and Safety Regulations available:
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 9
TUBERCULOSIS MANAGEMENT PROGRAM QUICK
REFERENCE
Goal is to prevent transmission of TB to staff and patients
Early diagnosis necessary
If TB suspected, implement Airborne Precautions immediately – place patient in Airborne Isolation
room and staff to wear N95 respirators
Place appropriate Airborne Precautions sign on door and ensure that the negative pressure is
turned on and working. Room pressure must be checked each shift.
Collect 3 sputum specimens 8 – 24 hours apart with at least one being an early morning specimen
Patient to wear surgical/procedure mask when outside of Airborne Isolation room
Visitors to be offered N95 respirator – teach re seal check
Children should not visit
Discontinue Airborne Precautions only on approval from ICP, Infectious Disease physician,
Respirologist, or Medical Director for IP&C
When Airborne Precautions are discontinued and room is cleaned, 45 minutes is required to
remove airborne contaminants
Discharge planning done collaboratively with Public Health and others – requires minimum of 3
working days to ensure necessary services are organized and available
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 10
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500A (Tuberculosis)
Page 11
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500B (Tuberculosis Risk Screening-Adult Residential
Care Facilities, Group Homes, Mental Health Care Facilities)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is located
on IHNET at the Policies & Procedures Home Page
IS0500B
Tuberculosis Risk Screening –
Adult Residential Care Facilities, Group Homes,
Mental Health Care Facilities
EFFECTIVE DATE: July 2007
REVISED DATE: November 2010,
June 2016
REVIEWED DATE:
1.0
PURPOSE
To ensure persons with active respiratory tuberculosis are excluded from admission to an Adult
Residential Care Facility (including Group Homes and Mental Health Care Facilities) until they have
been appropriately treated and are no longer infectious.
The Medical Health Officer may make alternative policy decisions based on local disease incidence
and prevalence.
2.0
DEFINITIONS
Risk factors for tuberculosis (TB) include:
 Contacts to active cases of TB disease
 Persons born in or travelled to high TB incidence countries
 Current or historical residence in a First Nations, Métis, or Inuit communities
 Homeless or under-housed (i.e. shelter users, those with no fixed address)
 Residents of congregate living settings (i.e. correctional facilities, long-term care facilities,
residential treatment programs)
 Immune compromised or illness affecting immunity ( i.e. persons with HIV)
Symptoms of Active Respiratory TB Disease:
Systemic Signs and Symptoms of Active TB
Disease
 Fever*
 Night sweats*
 Loss of appetite (anorexia)
 Unexplained weight loss
 Fatigue
Signs and Symptoms of Respiratory TB Disease





Cough (dry or productive) for two to three
weeks or longer with or without fever or
phlegm
Bloody sputum (hemoptysis)
Chest pain
Shortness of breath
Abnormalities on chest x-ray**
* May be absent in the very young and elderly
** Radiographic presentation can be atypical in clients who are immune compromised
Immune compromised defined as persons with HIV infection; transplant recipient on immune
suppressing treatment; chronic renal failure and/or dialysis and/or other conditions per clinical
judgment/consultation with TB Services; taking (or about to begin) treatment with immune suppressing
therapies such as TNF alpha inhibitors, chemotherapy, or systemic corticosteroids (equivalent of ≥ 15
mg/day of prednisone for 2 weeks or longer)
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500B (Tuberculosis Risk Screening-Adult Residential
Care Facilities, Group Homes, Mental Health Care Facilities)
Page 2
3.0
GUIDING PRINCIPLES
All persons being admitted to a licensed Adult Residential Care Facility need to be screened for signs
and symptoms associated with active TB disease. This process needs to be completed prior to the
person being admitted to the care facility, may occur while the person is still living at home or while
the person is in the hospital and can be done within one month prior to admission if not symptomatic.
This information will be recorded on the person’s chart.
As per the Medical Health Officer 2016, this excludes client stays of less than 30 days and
Community Hospice Bed admissions (palliative care clients).
If a client remains in convalescent or respite care for greater than 30 days, they do require TB
screening.
4.0
PROCEDURE
4.1
Prior to admission to an Adult Residential Care Facility, a risk assessment
must be performed using the IH Tuberculosis Risk Screening for Residential Care
Facilities, Group Homes and Mental Health Care Facilities (#811217) form:
 The Home Health Nurse performs for persons in community
 The Transition Liaison Nurse performs for patients in hospital
 Mental Health staff perform for persons entering Mental Health Care facilities
 Can be done within one month prior to admission if person not symptomatic
4.2





4.3


4.4


For all persons who are less than 60 years old:
A tuberculin skin test (TST) must be done, unless contraindicated
o If client is in the community, refer client to Public Health Nursing for TST
o If client is admitted to hospital, nursing staff will perform the TST
In addition, for those persons who have symptoms of respiratory TB disease a
chest x-ray is required – see 4.4 below
If the person has a positive TST, a chest x-ray is required – see 4.4 below
If the person has a TST contraindication, or is immune compromised, a chest xray is required – see 4.4 below
Contraindications for a TST include prior allergic response or severe reaction to a
TST, previous positive TST reaction, previous reactive IGRA (interferon gamma
release assay), previous active TB disease and burns or eczema at test site
For persons who are 60 years and over:
With no symptoms of respiratory TB disease, no further action is required
Who have symptoms of respiratory TB disease, a chest x-ray is required – see
4.4 below
Process for having chest x-ray done
Person doing the client assessment completes all sections under Part 1 and 2 of the
BCCDC TB Screening Form – http://www.bccdc.ca/resourcegallery/Documents/Guidelines%20and%20Forms/Forms/TB/CPS_TB_ScreeningFor
m939_20150722.pdf
Ensure that the MRP’s (most responsible physician) name is listed on the form.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500B (Tuberculosis Risk Screening-Adult Residential
Care Facilities, Group Homes, Mental Health Care Facilities)
Page 3






4.5



5.0
Ensure that the name of the person who needs to receive recommendations back is
listed in the “Additional Comments” section (i.e. ‘Please send recommendations to
Jane Smith, Home Health Nurse’; include mailing address)
Send the last page of the BCCDC TB Screening Form with the client to the
radiology provider (this page automatically populates when information is entered
electronically into Part 1 and Part 2 of the form)
Send the first page of the BCCDC TB Screening Form to BCCDC TB Services
Recommendations from BCCDC TB Services are communicated back to providers
via the BCCDC TB Screening Form and/or physician narratives
If a chest x-ray is required, refer person to MRP (most responsible physician) for
follow up; (MRP to order sputum for AFB/TB culture if person has productive cough)
Person cannot be admitted to a residential care facility until assessment by MRP and
BCCDC TB Services has ruled out presence of active respiratory TB disease
Documentation
Place the completed IH Tuberculosis Risk Screening form #811217 on the
person’s file
When the person is admitted to an Adult Residential Care facility, Group Home or
Mental Health Care facility, send a copy of the completed IH Tuberculosis Risk
Screening form #811217 to the admitting facility; this meets the licensing
requirements by having the completed form on file
If person was sent for chest x-ray and referral to BCCDC TB Services, include
recommendations from TB Services
REFERENCES
5.1 British Columbia Centre for Disease Control: Tuberculosis Manual. (November 2015)
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0500B (Tuberculosis Risk Screening-Adult Residential
Care Facilities, Group Homes, Mental Health Care Facilities)
Page 4
Tuberculosis Risk Screening for Residential Care
Facilities - Form #811217
Note: in this document the term “patient” is inclusive of patient, resident or client.
EFFECTIVE DATE: July 2007
REVISED DATE: June 2016
REVIEWED DATE: November 2010
Infection Prevention and Control
Section 08S – IS0600 (Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0600:
EFFECTIVE DATE: September 2006
Chickenpox (Varicella-Zoster) and
Herpes Zoster (Shingles)
REVISED DATE: November 2010,
December 2012
REVIEWED DATE:
1.0 PURPOSE
To prevent the spread of Varicella-zoster and herpes zoster to patients and staff.
2.0 DEFINITIONS
Varicella-zoster virus (VZV) – is the causative agent of two diseases:
 Varicella (chickenpox), the primary infection.
 Herpes zoster (shingles), a secondary infection due to a reactivation of latent varicella infection
in the dorsal root ganglia.
Chickenpox – typically infects children under the age of 10 years.
 Transmitted from person to person by direct contact, droplet or airborne spread of vesicle fluid or
sections of the respiratory tract and indirectly through articles freshly soiled by discharges from
vesicles or mucous membranes of infected people.
 Incubation period between 10-21 days.
 Is most contagious from 2 days before onset of rash until all lesions have crusted.
 Susceptible persons should be considered potentially infectious 7 to 21 days following exposure.
 Scabs from the lesions are not infective.
Shingles – lifetime risk of reactivation as zoster/shingles is about 15-20%.
 Can occur any time, most often in the elderly population
 Vesicles with an erythematous base appear in crops in irregular fashion along nerve pathways.
 Severe pain and paresthesia are common.
 Transmitted from person to person by direct contact, droplet or airborne spread of vesicle fluid
and indirectly through articles freshly soiled by discharges from vesicles or mucous membranes
of infected people.
 Scabs from the lesions are not infective.
Localized Shingles – localized lesions (< 2 dermatomes).
Disseminated Shingles – must be diagnosed by physician; very rare
Immunocompromised patients – those with cancer, especially leukemia and lymphoma; those with
HIV; those who have undergone bone marrow or solid organ transplantation; those who are taking
immunosuppressive medications, including steroids, chemotherapy, or transplant – related
immunosuppressive medications; patient status determined by the physician.
Healthcare Worker Exposure Contact – non immune staff that have had contact with a patient
with varicella who is not on Airborne/Contact Precautions.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0600 (Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)
Page 2

Healthcare provider exposure: Contact WH&S 1-866-922-9464 or email
[email protected].

NOTE: Immune staff does NOT need to wear N95 respirator in patient room.
3.0 PROCEDURE
Precautions
1.
Chickenpox
(Varicella Zoster)
2.
Airborne
Contact

Infective
material
Respiratory

secretions +
drainage from
lesions
Duration of
Precautions
Until all lesions 
are crusted and 
dry
Notify/ Comments
HCWs must be immune
Non-immune HCW that
must enter room must
wear N95 respirator
Shingles
2a.


2b.


2c.
(Herpes Zoster)
Immunocompetent
patient with:
Localized lesions
AND
Lesions can be
covered with clothing
or dressing
Routine Practice
Immunocompetent
patient with:
Localized lesions
AND
Lesions cannot be
covered with a
dressing
Contact
Immunocompromised
patient with localized
Airborne
Contact

Drainage from
lesions
Drainage from 
lesions
Until all lesions

are crusted and

dry

shingles
Precautions

Drainage from 
lesions and
possibly
respiratory
secretions

Until 72 hours of 
effective antiviral 
treatment
OR
If untreated until
all lesions are
crusted & dry
Infective
material
Duration of
Precautions
Note: in this document the term “patient” is inclusive of patient, resident or client.
All HCW must be immune
HCW exposure: If nonimmune individuals are
exposed to vesicular fluid
Roommate should be
immune to Chickenpox
HCWs must be immune
Non-immune HCW that
must enter room must
wear N95 respirator
Notify/ Comments
Infection Prevention and Control
Section 08S – IS0600 (Chickenpox (Varicella-Zoster) and Herpes Zoster (Shingles)
Page 3
2d.
Patient with
disseminated
shingles
Airborne
Contact

Drainage from
lesions and
possibly
respiratory

secretions



Discontinue
precautions:
72 hours after
start of effective
antiviral therapy
AND
No new lesions
appear
AND
Existing lesions
are crusted and
dried
OR
If untreated until
all lesions are
crusted and dry


HCWs must be immune
Non-immune HCW that
must enter room must
wear N95 respirator
4.0 Dermatomes – for a diagram of the levels of principal dermatomes
5.0
REFERENCES
4.1.
B.C. Centre for Disease Control (BCCDC) Communicable Disease Manual – Varicella
Zoster; July 2004.
4.2.
Alberta Health Services Infection Prevention and Control Manual 2012.
4.3.
CDC Center for Disease Control and Prevention – Shingles (Herpes Zoster); 2012.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0700 (Invasive Group A Streptococcal Infections (IGAS)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0700:
Invasive Group A Streptococcal
Infections (IGAS)
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
September 2014
REVIEWED DATE:
1.0
PURPOSE
To prevent transmission of Invasive Group A Streptococcal infections to patients and staff.
To provide guidance to staff on how to report a case of Invasive Group A Streptococcal Disease.
2.0
DEFINITION
Invasive Group A streptococcal (invasive GAS) disease is caused by Streptococcus pyogenes, a
gram-positive coccus. Certain strains of S. pyogenes are associated with severe invasive disease.
Clinical manifestation of severe invasive disease include: streptococcal toxic shock syndrome
(STSS), soft-tissue necrosis, including necrotizing fasciitis (NF), myositis or gangrene, meningitis,
pneumonia or death directly attributable to GAS infection. Case fatality rate overall is 15-20%.
Mortality is reduced by early diagnosis with surgical intervention for NF, antibiotic treatment and
supportive management.
Invasive GAS disease is confirmed through laboratory testing of specimens taken from normally
sterile sites.
2.1
Mode of transmission
 Primarily by large droplet contact of the oral or nasal mucous membranes with infectious
respiratory secretions or with exudates from wounds or skin lesions
 Or by direct or indirect contact with non-intact skin with exudates from skin or wound or
infectious respiratory secretions
 Transmission by contaminated equipment has rarely been reported
2.2
Incubation Period
 The incubation period for invasive GAS infection has not been determined
 The incubation period for non-invasive GAS infection is usually 1-3 days
2.3
Period of communicability
 In untreated cases 10 – 21 days
 Transmissibility generally ends within 24 hours of appropriate antibiotic therapy
 Evidence to date suggests the use of prophylaxis in close contacts may prevent severe
illness
2.4
Confirmed Case
 Laboratory confirmation of infection with or without clinical evidence of invasive disease
 Isolation of group A streptococcus (Streptococcus pyogenes) from a normally sterile site
(blood, cerebrospinal fluid (CSF), pleural fluid, pericardial fluid, peritoneal fluid, deep
tissue specimens taken during surgery [e.g. muscle collected during debridement of
necrotizing fasciitis], bone or joint fluid excluding the middle ear and superficial wound
aspirates [e.g. skin and soft tissue abscesses]).
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0700 (Invasive Group A Streptococcal Infections (IGAS)
Page 2

3.0
4.0
When fetal demise occurs in association with a puerperal infection, isolation of group A
streptococcus from the placenta, amniotic fluid and/or endometrium is also considered
confirmatory for both the mother and the fetus.
2.5
Probable Case
 Streptococcal toxic shock syndrome (STSS) is characterized by hypotension (systolic
blood pressure of ≤ 90 mmHg in adults AND at least two of the following signs: renal
impairment, coagulopathy including disseminated intravascular coagulation, liver function
abnormality, adult respiratory distress syndrome (ARDS), or generalized erythematous
macular rash that may desquamate
 Necrotizing fasciitis (NF) is characterized by isolation of group A streptococci
(Streptococcus pyogenes) from a normally sterile body site or taken under sterile
conditions from deep tissue (aspirate) AND at least one of the following: histopathologic
diagnosis (tissue necrosis) or clinical diagnosis; gross fascial edema and necrosis
2.6
HCW Close Contact
 Exposure to the case during the period from 7 days prior to onset of symptoms in the
case to 24 hours after the case’s initiation of antibiotics
 HCWs who have had direct mucous membrane contact with the oral or nasal secretions
of a case (e.g. mouth-to-mouth resuscitation) or unprotected direct contact with an open
skin lesion of the case
 Chemoprophylaxis is indicated only for close contacts of cases presenting with clinical
evidence of severe invasive GAS disease
PROCEDURE
3.1
Additional Precautions

Confirmed or suspected invasive cases must be placed on Droplet/Contact
Precautions.
3.2
Discontinuing Precautions

Precautions may be discontinued after the patient has received 24 hours of appropriate
antimicrobial therapy.
3.3
Reporting

Report case to Infection Control who will complete the Communicable Disease
Notification Tool (only available to Infection Control Practitioners)

If Infection Control is not available then report case to the CD Unit (1-877-778-7736)
Monday to Friday 0830-1630 or the Medical Health Officer On-Call (1-866-457-5648)
after hours.
3.4
Management of Contacts

Community contacts will be identified and followed up by the CD Unit – see BCCDC
guidelines.

Chemoprophylaxis may be recommended for close contacts of severe invasive GAS
cases under the direction of the Medical Health Officer

Healthcare workers may qualify for close contact chemoprophylaxis if Droplet/Contact
Precautions were not used during care of severe invasive GAS cases.
REFERENCE
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0700 (Invasive Group A Streptococcal Infections (IGAS)
Page 3
BC Centre for Disease Control Communicable Disease Control Manual. Invasive Group A
Streptococcal Disease. April 2014.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0800 (Meningococcal Infection)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0800:
Meningococcal Infection
EFFECTIVE DATE: April 2009
REVISED DATE: November 2010
REVIEWED DATE:
1.0
PURPOSE
To prevent transmission of Meningococcal infection to patients and staff.
To provide guidance to staff on how to report a case of Meningococcal disease to Public Health.
2.0
DEFINITION
Meningococcal disease
Meningococcal disease is caused by the bacteria Neisseria meningitides (N. meningitides). The
bacteria can be found naturally in the throat or nose of 5-10% of the population, only rarely giving rise
to illness. However, when illness does occur, the infection can progress rapidly and is fatal in about 1
in 10 cases, striking young children and young adults most frequently.
The two most common presentations of invasive meningococcal disease are meningitis and
septicaemia.
The symptoms of meningococcal meningitis are identical to those of other forms of acute
bacterial meningitis. Signs of meningitis include sudden onset of fever, headache, and stiff neck.
Other symptoms frequently seen are nausea, vomiting, light sensitivity and altered mental status.
A petechial rash with pink macules may occasionally be observed.
Meningococcal septicaemia can occur with or without meningitis and may progress rapidly to
purpura fulminans (hypotension, fever and disseminated intravascular coagulation), shock and
death.
Less common presentations of meningococcal disease are purulent primary meningococcal
conjunctivitis and primary meningococcal pneumonia.
Infectious Period

The incubation period is most commonly 3-4 days but can range from 2 to 10 days.

Persons are communicable for 7 days prior to onset of symptoms until 24 hours after
initiation of appropriate antibiotic therapy.
Transmission
 Person to person spread occurs through direct contact with respiratory droplets from the
nose and throat of infected people.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0800 (Meningococcal Infection)
Page 2
3.0
PROCEDURE
3.1


3.2

3.3






4.0
Additional Precautions
Confirmed or suspected cases must be placed on Droplet Precautions (Droplet/Contact
Precautions for pediatric patients).
Gloves should be worn for contact with eye secretions of cases of primary meningococcal
conjunctivitis.
Discontinuing Precautions
Precautions may be discontinued after the patient has received 24 hours of appropriate
antimicrobial therapy.
Reporting
Report case to Infection Control who will report case to Public Health.
If Infection Control is not available then report case to Public Health via the CD Unit (1-866778-7736) Monday to Friday 0830-1630 or the Medical Health Officer On-Call (1-866-4575648) after hours.
Contacts will be identified, notified of recommendations and provided direction regarding
medication distribution by Public Health.
Chemoprophylaxis may be considered and is provided free of charge for close contacts of
invasive meningococcal disease and primary meningococcal conjunctivitis cases under
authorization of the Medical Health Officer.
Chemoprophylaxis is only recommended for healthcare workers who have had intensive
unprotected contact (without wearing a mask or eye protection) with infected patients (i.e.
intubating, resuscitating, or closely examining the oropharynx) or unprotected contact with
the purulent discharge from the eye of a case of primary meningococcal conjunctivitis.
Infection Control will ask Unit Managers to identify healthcare workers who meet the above
close contact definition with the patient since admission to 24 hours post treatment and
report these names to the Occupation Health Nurse Specialist for follow-up.
REFERENCES
4.1
Control of Communicable Disease Manual (19th edition). Heymann, D. (Ed). American
Public Health Association (2008).
4.2
Communicable Disease Control Manual. Meningococcal Disease. BC Centre for
Disease Control. February 2009.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0900 (Creutzfeldt-Jakob Disease)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS0900:
Creutzfeldt-Jakob Disease
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
December 2012
REVIEWED DATE:
1.0 PURPOSE
To prevent the transmission of Creutzfeldt-Jakob Disease (CJD) to patients.
2.0 DEFINITION
Creutzfeldt-Jakob Disease (CJD) is an infection which causes progressive mental deterioration and
muscle weakness. It is often difficult to differentiate CJD from other forms of dementia. CJD is caused
by a small agent called a prion. Diagnosis is based on clinical signs, periodic EEG and brain material
histopathology. Confirmation of CJD does not usually occur until autopsy.
2.1.
Infectious Period
 Incubation can be 6 months or as long as 30 years.
 There is no effective treatment.
 Patients are infectious throughout the symptomatic period.
2.2.
Transmission
 CJD is not known to be spread person to person through routine direct or indirect contact.
Transmission has been documented via corneal transplantation, contaminated neurological
electrodes, dura mater grafts and injections of growth hormone or human pituitary gland
origin.

Risk is higher in the Operating Room, Laboratory, CSSD and Autopsy Suite.
Infectious Materials
CSF, brain, spinal cord and eye. Other
tissues that may be infectious and require
cautious handling are lymph glands
kidney and lung.
Non-infectious Materials
Sweat, tears, saliva, stool and urine.
Breast milk is also considered
noninfectious.
3.0 PROCEDURE
3.1.
When a patient is suspected of having CJD, notification shall be given to Infection Control
who will report case to Public Health. If Infection Control is not available then report case to
Public Health via the CD Unit (1-877-778-7736) Monday to Friday 0830-1630 or the Medical
Health Officer On-Call (1-866-457-5648) after hours.
3.2.
Transfer of the patient to any other department requires notification of CJD status. This is
especially important for departments who will do invasive procedures - Imaging, O.R., morgue.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS0900 (Creutzfeldt-Jakob Disease)
Page 2
3.3.
As there is controversy about the effectiveness of sterilizing instruments used on CJD patients, a
minimum of reusable instruments should be used as they will need to be discarded following
use.
3.4.
To control possible exposure:
 Restrict traffic and access to areas where a CJD patient is undergoing invasive procedures.
Use manual saws for craniotomies to decrease splatter and aerosolization.
 Double glove for surgery or autopsy. Hats, masks, eyewear, gowns and shoe covers should
also be used. Use disposable products and incinerate after using.
 No organs are to be procured for transplantation from patients with CJD. CJD patients may
not donate blood.
 All contaminated liquids, including rinse water and suctioned materials from surgery or
autopsy, must be retained and incinerated.
 Clearly label all specimens that are sent to the laboratory which are potentially infected with
CJD.
 Decontaminate all exposed surfaces with 1 Eq/L sodium hydroxide for 60 minutes. Rinse
thoroughly with water, then proceed with regular cleaning.
 All trash, needles and other disposables should be contained as biomedical waste.
4.0 REFERENCES
4.1.
Creutzfeldt-Jakob Disease in Canada Quick Reference Guide 2007 - Public Health
Agency of Canada.
4.2.
IH Surgical Services Practice Manual.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1000 (Respiratory Viruses)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS1000:
1.0
Respiratory Viruses
(replaced RSV guideline)
EFFECTIVE DATE: June 13, 2016
REVISED DATE:
REVIEWED DATE:
PURPOSE
To prevent transmission of respiratory viruses including Influenza, Parainfluenza, Respiratory
Syncytial Virus (RSV), Adenovirus, Human Metapneumovirus (hMPV), Coronavirus, Rhinovirus to
patients and staff.
2.0
DEFINITIONS
In general, respiratory viruses can cause acute upper respiratory tract infection in most people.
Lower respiratory tract infections are more common in children < 1 year old and in the elderly with
chronic pulmonary disease or functional disability.
Symptoms include:
 Acute onset of illness with a fever (>38C) and cough
 Sore throat
 Nasal congestion
 Malaise
 Chills
 Muscle/joint aches
 Headache
 Change in respiratory or mental status
**NOTE: In the elderly, fever may not be present
2.1
Mode of transmission
 Droplet transmission via direct contact with virus-containing secretions (i.e.) when
person coughs or sneezes
 Direct/indirect contact with virus-containing secretions on contaminated hands or
surfaces/equipment (viruses may persist on environmental surfaces for hours)
2.2
Incubation period
 Generally 1-3 days; varies depending on causative virus
2.3
Period of communicability
 Generally 3-7 days from onset of symptoms
 Viral shedding may be longer in infants or immunocompromised persons
2.4
Diagnostic testing
 Nasal (or nasopharyngeal) swab or washings for respiratory virus
 Specimens should be collected from symptomatic persons within 48 to 72 hours of
onset of symptoms
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1000 (Respiratory Viruses)
Page 2
3.0
4.0
5.0
GUIDING PRINCIPLES
3.1
Healthcare workers are rarely at risk for acquiring respiratory viruses when using Routine
Practices appropriately, including a point of care risk assessment (PCRA). When the PCRA
indicates a potential respiratory illness, then Droplet & Contact Precautions should be
implemented.
3.2
Watch carefully for other patients or healthcare workers with developing respiratory
symptoms. If unit transmission is suspected, notify the Infection Control Practitioner.
PROCEDURE
4.1
Additional Precautions
 Place on Droplet & Contact Precautions
 Staff to wear a surgical/procedure mask and eye protection when within 2 metres of
patient as well as gown and gloves for direct patient contact
4.2
Discontinuing Additional Precautions
 Based on the point of care risk assessment – if symptoms have resolved, Droplet
and Contact Precautions can be discontinued (up to 7 days from clinical onset in
young children and immunocompromised persons)
 For patients with Influenza who have been on antiviral treatment for 5 days, do a
point of care risk assessment – if symptoms have resolved, Droplet and Contact
Precautions can be discontinued
 Consult Infection Control Practitioner with questions or concerns
REFERENCES
5.1
Provincial Infection Control Network of British Columbia (PICNet BC). (February 2011).
Respiratory Infection Outbreak Guidelines for Healthcare Facilities.
https://www.picnet.ca/practice-guidelines
5.2
Centre for Disease Control and Prevention (July 2010) Interim guidance of Infection
Control Measures for H1N1 Influenza in Healthcare Settings, Including protection of
Healthcare Personnel http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
5.3
Public Health Agency of Canada (2010) Respiratory Syncytial Virus http://www.phacaspc.gc.ca/lab-bio/res/psds-ftss/pneumovirus-eng.php
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1100 (Rabies)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS1100:
Rabies
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
REVIEWED DATE:
1.0
PURPOSE
To prevent transmission of Rabies to patients and staff.
To provide guidance to healthcare workers on how to report a case of rabies.
2.0
DEFINITION
Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid
animal. The vast majority of rabies cases reported to the Centers for Disease Control and Prevention
(CDC) each year occur in wild animals like raccoons, skunks, bats, and foxes. Domestic animals
account for less than 10% of the reported rabies cases, with cats, cattle, and dogs most often
reported rabid.
Rabies virus infects the central nervous system, causing encephalopathy and ultimately death. Early
symptoms of rabies in humans are nonspecific, consisting of fever, headache, and general malaise.
As the disease progresses, neurological symptoms appear and may include insomnia, anxiety,
confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation, difficulty
swallowing, and hydrophobia (fear of water). If vaccinations to prevent disease are not administered
before the onset of symptoms, death is almost certain.
2.1. Infectious Period
 Depends on animal. Cats and dogs are infectious 3-7 days prior to symptoms.
2.2. Transmission
 Virus-laden saliva of rabid animal introduced through a scratch or bite. Person to Person
transmission is theoretically possible, but rare and not well documented. Organ transplants
of persons dying of undiagnosed CNS disease have lead to transmission of rabies.
3.0
PROCEDURE
3.1. Routine Practices only. No isolation required.
3.2. Reporting
 Contact Infection Control.
If Infection Control is not available then please contact Public Health.The Medical Health
Officer of Health must be notified as Rabies is a Reportable Communicable Disease.
REFER TO IS0100 – REPORTABLE COMMUNICABLE DISEASES
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1100 (Rabies)
Page 2
3.3.Prophylaxis
 Please review the following BCCDC document.
4.0
REFERENCE
See B.C. Centre for Disease Control (BCCDC) for Rabies Protocol (July 2009):
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1200 (Measles)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS1200
Measles
EFFECTIVE DATE: February 2012
REVISED DATE: December 2012
December 2014
REVIEWED DATE:
1.0
PURPOSE
To prevent transmission of measles to patients and staff.
To provide guidance to healthcare workers on how to report a case of measles.
2.0
DEFINITIONS
Measles (rubeola) is caused by a virus and is one of the most contagious of all infectious diseases,
with >90% attack rates among susceptible close contacts. Initial symptoms include 2-4 days of fever,
cough, runny nose and red inflamed eyes (prodromal period) followed by a maculopapular rash,
starting on the face and neck, spreading to the chest, arms and legs lasting at least 3 days. Koplik
spots may appear on the inside of the mouth.
Complications include ear infections, pneumonia and encephalitis (1 out of every 1000 cases) and
are most common in infants < 12 months of age. Measles during pregnancy results in a higher risk of
premature labor, spontaneous abortion and low birth weight infants.
In BC most clusters and outbreaks of measles occur in association with imported cases. BC has
experienced two larger outbreaks (2010 and 2014) in recent years, typically lasting not more than two
to three months.
Healthcare worker (HCW) contact identification – HCWs include students, physicians, facility
employees, emergency responders and others who were in a shared airspace with the case or for up
to 2 hours after the case left the room/space. All of these individuals should be assessed with
respect to their exposure.
2.1
Mode of transmission
 Airborne by aerosol and droplet spread, direct contact with nasal or throat secretions of
infected persons
 Less commonly spread by articles freshly soiled with nose and throat secretions
2.2
Incubation period
 Average is 8 – 12 days with a range of 7 – 18 days, rarely may be as long as 21 days
2.3
Period of communicability
 From 1 – 2 days before the beginning of the prodromal period (usually about 4 days
before rash onset) to 4 days after rash appearance in a healthy person and for the
duration of measles illness in an immunocompromised person
2.4
Diagnostic testing - all specimens are sent to BCCDC for testing
 Virus detection in nasopharyngeal swab and urine
 Serology testing for measles specific IgM and IgG class antibodies
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1200 (Measles)
Page 2
3.0
4.0
GUIDING PRINCIPLES
3.1
Immune persons include the following:
 Birth date before January 1, 1970 (1957 for HCWs – these persons are assumed to have
acquired immunity to measles from natural infection. Those without a history of measles
disease should be considered susceptible and offered vaccine.
 Documented evidence of vaccination with 2 valid doses of live measles-containing
st
vaccine after their 1 birthday and given at least one month apart.
 Laboratory evidence of immunity
 Laboratory evidence of prior measles infection
3.2
A baseline assessment of all healthcare workers immunity and vaccination status against
measles needs to be done by WH&S.
3.3
Only immune healthcare workers should enter a room where airborne precautions are in
place for measles; an N95 respirator is not required.
3.4
An N95 respirator must be worn if non-immune health care providers are required to enter
the room of a patient with measles when there are no qualified immune healthcare providers
available and patient safety would be compromised if they did not provide care.
PROCEDURE
4.1
Additional Precautions
 Confirmed or suspect cases must be placed on Airborne Precautions – do not await
laboratory confirmation of the case
4.2
Discontinuing Precautions
 Precautions may be discontinued 4 days after the onset of the rash in healthy individuals
 Precautions must remain in place for the duration of the illness in immunocompromised
patients
4.3
Reporting
 Investigate all clinically identified and laboratory reports of measles within 24 hours and
immediately notify the CD Unit (1-866-778-7736) Monday to Friday 0830-1630 or the
Medical Health Officer On-Call (1-866-457-5648) after hours
 Report case to Infection Control who will complete the Communicable Disease Notification
Tool (Available to Infection Prevention Control Practitioners only)
4.4
Management of Susceptible Exposed Patients
 Follow up exposed inpatients born after 1970 to ensure they have been immunized; all
other patients to be monitored for signs and symptoms of measles
 CD Unit to follow up with any patient contacts who have been discharged
4.5
Management of Susceptible Exposed Healthcare Worker
 Consider excluding HCW from any work in the health care setting from 5 days after the
first exposure to 21 days after the last exposure regardless of whether the HCW received
measles vaccine or immune globulin after the exposure
 Follow up provided by MHO and/or WH&S – See BCCDC guidelines
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1200 (Measles)
Page 3
4.6
5.0
Exclusion of Healthcare Worker Case of Measles
 Healthcare workers who are diagnosed with measles should be excluded from work for at
least four days after the onset of a rash
 Follow up provided by MHO and/or WH&S – See BCCDC guidelines
REFERENCE
5.1
BC Centre for Disease Control Communicable Disease Control Manual – Measles;
June 2014.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1300 (Mumps)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS1300
Mumps
EFFECTIVE DATE: February 2012
REVISED DATE: December 2012
REVIEWED DATE:
1.0
PURPOSE
To provide guidance to staff on how to report a case of mumps to Public Health.
To prevent transmission of mumps to patients and staff.
2.0
DEFINITIONS
Mumps is a severe illness caused by the mumps virus. Mumps was previously a childhood disease
however, now it is more common in young adults. Symptoms include fever, aches and pains,
headaches and swelling of the salivary glands, especially in the parotid glands. Up to 1 in 5 people
do not have symptoms; however they can still spread the mumps virus to other people.
Complications of mumps includes painful swelling of the testicles in about 1:4 adult men and postpubertal boys and swelling of the ovaries in about 1:20 women – both of these conditions are
temporary and rarely result in permanent damage or sterility. Mumps can also cause temporary or
permanent deafness or serious illness such as encephalitis which can lead to convulsions or brain
damage. Mumps in early stages of pregnancy may increase the rate of miscarriage. Mumps do not
appear to cause birth defects.
Healthcare provider (staff) contact of a case of mumps – defined as individuals who have had
direct contact with oral/nasal secretions of an infectious case of mumps.
Prodomal period – the time during which the infectious process has begun but is not yet
clinically manifested by signs and symptoms.
WH&S - Workplace Health and Safety – provides the baseline assessment of all healthcare workers’
immunity and vaccination status and follow up in cases of an occupational exposure
2.1. Infectious Period
 Usually 16-18 days to onset of prodromal signs and symptoms
 Symptoms can appear from 16-25 days after a person is infected with the mumps virus
 A person with mumps can spread the virus to others from 7 days before to 9 days after
symptoms develop.
2.2. Transmission
 Direct contact with saliva or respiratory droplets that are aerosolized from the nose or throat
 Spread through coughing, sneezing, sharing drinks, or kissing, or from contact with any surface
that has been contaminated with the mumps virus.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1300 (Mumps)
Page 2
2.3. Diagnostic testing
 Done by both serology and virus detection.
 Requires collection of both acute and convalescent serum specimens.
 If patient presents at ≤ 5 days after symptom onset, collect oral specimen.
 If patient presents at > 5 days after symptom onset, collect urine specimen.
 Buccal swab or saliva from the buccal cavity collected within the first 3 to 5 days of parotitis or
symptom onset is the preferred specimen.
 All specimens are sent to BCCDC for testing.
3.0
GUIDING PRINCIPLES
Mumps immunity is based on the following:
 Born prior to 1957 – considered immune.
 Born between 1957-1969 require only one dose of MMR.
 Born after 1970 – will receive two doses of MMR.
4.0
PROCEDURE
o
4.1
Additional Precautions
 Confirmed or suspect cases must be placed on Droplet Precautions – do not await
laboratory confirmation of the case.
4.2
Discontinuing Precautions
Precautions may be discontinued 9 days after the onset of parotid swelling.
4.3
Reporting
 Investigate all clinically identified and laboratory reported cases of mumps as soon as
possible and immediately notify the CD Unit (1-866-778-7736) Monday to Friday 08301630 or the Medical Health Officer On-Call (1-866-457-5648) after hours
 Report case to Infection Control
 Infection Control will ask Unit Managers to identify staff who meet the contact definition
with the patient since admission and report these names to WH&S for follow-up
4.4
Management of Non-immune Healthcare Provider Contacts to a Case of Mumps
 Offer MMR vaccine to susceptible contacts who do not have a contraindication to the
vaccine.
 Although mumps immunization after exposure to mumps may not prevent the disease, it
is not harmful.
 Immune globulin is not recommended for mumps for post exposure prophylaxis
 Exclude the healthcare provider from the 10th day after the first exposure until the 26th
day (inclusive) after the last exposure to the case of mumps.
 Refer to WH&S for follow up and BCCDC guidelines
.
4.5
Management of Healthcare Provider (Staff) Cases of Mumps
 Healthcare providers who are diagnosed with mumps should be excluded from work
until at least five days after the onset of salivary gland swelling.
 This exclusion may be extended up to 9 days if the healthcare provider remains
symptomatic or if they work with vulnerable patients (e.g., immunocompromised).
 Staff working with immunocompromised or other vulnerable patients may be
reassigned to another area after day five, at the discretion of WH&S.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 08S – IS1300 (Mumps)
Page 3

5.0
Prior to return to work the healthcare provider should contact WH&S to ensure they are not
longer contagious.
REFERENCE
5.1
Communicable Disease Control Manual - Mumps. BC Centre for Disease Control Interim
June 2011.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section IS1400 – Bed Bugs
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS1400
Bed Bugs
EFFECTIVE DATE: December 2012
REVISED DATE:
REVIEWED DATE:
6.0
PURPOSE
To prevent transmission of bedbugs to patients and staff.
7.0
DEFINITIONS
Bed bug – is a small reddish brown oval shaped insect with a flattened
body. The size is 5-7mm long or the size of a lady bug. Bed bugs are
classified as blood-sucking parasites on warm-blooded hosts.
Bed bugs ARE NOT ASSOCIATED with the transmission of human disease.
8.0
GUIDING PRINCIPLES
8.1


8.2





8.3






Background Information:
For the past fifty years, bed bugs were a relative rarity amongst pest control professionals. In
the last five years, bed bugs have been increasingly encountered in homes, apartments,
hotels, motels, dormitories, shelters and modes of transport. As such, they are occasionally
transported into hospital and other health care environments.
Bed bugs have not been linked to the transmission of any disease and are not regarded as a
medical threat.
Biological Information:
Hide in cracks and crevices during the day and come out at night to feed.
Require blood meal for development.
Typical life span between 6 to 12 months.
Extreme heat (approx 45 degrees C) or cold is lethal – heat is more effective.
Cannot fly but can crawl quickly over floors, walls and ceilings. They also hitch rides on
clothing, furniture, purses and luggage.
Signs of Infestation:
If bed bugs are present there will be dark spotting and staining on sheets, mattresses, pillows
and carpets.
With severe infestations there will be a sweet musty odour.
Bed bugs usually bite people at night on any exposed skin – bite marks are typically raised
welts or localized swelling while others have no reaction at all.
Lesions are often itchy and remain itchy for weeks.
Main concern is the risk of secondary infection from scratching the lesions.
It is important to recognize that not all bites or bite-like reactions are due to bed bugs.
Confirmation requires finding and identifying the bugs themselves.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section IS1400 – Bed Bugs
Page 2
9.0
PROCEDURE
9.1

Acute Care – if a bed bug infestation is suspected:
Obtain a specimen if possible.

Place patient on Contact Precautions.
REFER TO IH0400 CONTACT PRECAUTIONS

Contain patient possessions and
potentially infested items in sealed
plastic bags – label and ensure separation from clean items.
Patients should be instructed NOT to remove any belongings from sealed bags.






4.2.



4.3
Instruct family to wash and dry washable items using high temperature.
Continue with routine cleaning and disinfection procedures. If any visible bedbugs noted in
the vicinity of the patient, wipe the area with a damp paper towel and discard in the garbage.
Seal the garbage bag and discard.
For patients in the Emergency Department who have suspected bed bugs and require
transfer to a unit, place that patient in a private room if possible until the source of the bug is
confirmed and treatment is complete.
Any decision to treat a room, evacuate a room or replace equipment will be made in
consultation with the unit staff involved, the unit leader, Housekeeping, Pest Control and
Infection Control as required and recommendations made on how to proceed will be
communicated with stakeholders.
A physician assessment can determine whether antihistamines and corticosteroids may be
prescribed to reduce allergic reactions, and antiseptic or antibiotic ointments to prevent
infection.
Infestations also may cause anxiety, embarrassment, and loss of sleep.
Residential Care
Train healthcare providers to look for bites on residents and talk to family members.
Train environmental and housekeeping staff on what to look for during routine
cleaning/maintenance.
If a bed bug infestation is suspected follow Acute Care information above.
Client Homes
 Wearing light coloured clothing will assist in easier detection of bedbugs. Avoid pants with
cuffs.
 Limit work items being brought into a client’s home. Only bring in what is essential.
 Store work items in a pest proof bag or container that items will remain bug free in. If none
are available, consider hanging your items rather than placing on furnishings.
 Utilize Routine Practice Guidelines. If providing direct care, consider wearing a gown if there
is heavy infestation.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section IS1400 – Bed Bugs
Page 3


4.4
Community Office
 Utilize Routine Practice Guidelines. If you suspect heavy infestation of bedbugs, wear gloves
and a gown to protect clothing.
 Place all personal belongings in a pest proof container during the visit. Backpacks and bags
are thought to be a means for transport of bedbugs. Clean the container with a moistened
paper towel and discard into the garbage. If any bedbugs are left in the container, shake into
the toilet and flush.
 Ideally the floor and chair should be a smooth surface and lightly coloured.
 Clean and disinfect equipment, stretcher, exam tables as per usual routine.
 If you see bedbugs crawling on the floor, vacuum up the bedbugs and immediately dispose
of the contents. If you use a dustpan and brush, transport the bedbugs to the toilet in a pest
proof container and dispose of in toilet. Store the brush in a pest proof container.
4.5 Staff

10.0
Equipment used on the client should be placed in a sealed bag and returned to the unit for
cleaning.
Inspect clothing and equipment for bedbugs after visit and remove any stragglers.
Contact Workplace Health and Safety if symptomatic.
REFERENCES
10.1
Providence Health Care Nursing Care Standards. 2007; Bed Bugs Protocol.
10.2
Vancouver Costal Health (VCH) - BED BUGS - VCH STAFF INFORMATION SHEET.
10.3
Vancouver Island Health Authority (VIHA) Infection Prevention & Control Manual.
2009; Bed Bug Infestation pg 78 – 79.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section IS1500 – Pertussis
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IS1500 Pertussis
EFFECTIVE DATE: June 13, 2016
REVISED DATE:
REVIEWED DATE:
1.0
PURPOSE
To prevent transmission of pertussis to patients and staff.
To provide guidance to healthcare workers on how to report a case of pertussis.
2.0
DEFINITIONS
Pertussis is an acute and prolonged infectious cough illness caused by Bordetella pertussis, a gramnegative bacterium. The duration of pertussis illness is usually 6 to 10 weeks in children. The clinical
course of pertussis is divided into 3 stages:
 Catarrhal stage (lasts 1 – 2 weeks); symptoms indistinguishable from a respiratory tract
infection; intermittent cough becomes paroxysmal
 Paroxysmal stage (usually lasts 1 – 6 weeks but may persist for up to 10 weeks); individual
has repeated bursts or paroxysms of numerous, rapid coughs that follow each other without
inspiration and may end with an inspiratory “whoop” and may be followed with mucous
production and vomiting
 Convalescent stage (lasts 2 – 6 weeks or longer); recovery is gradual with a paroxysmal
cough subsiding and decreasing frequency of coughing bouts
The most common complication of pertussis is secondary bacterial pneumonia.
Pertussis is highly infectious – the secondary attack rate exceeds 80% among susceptible persons.
Neither vaccination nor natural disease confers complete or lifelong protective immunity against
pertussis or re-infection.
The highest incidence of pertussis generally occurs in infants < one year of age.
Pertussis demonstrates cyclical peaks every three to five years.
Chemoprophylaxis – Purpose is to prevent disease in susceptible high-risk individuals exposed to a
case of pertussis and to decrease transmission to high-risk individuals. Chemoprophylaxis with
appropriate antibiotics eliminates B. pertussis from the nasopharynx of infected individuals.
Chemoprophylactic treatment of all high-risk contacts (regardless of immunization status and whether
they have symptoms) is recommended because immunization provides only partial protection and
immunized people can still harbour and transmit B. pertussis.
Contact Identification – Identify contacts that had the following types of contact with the case during
the period of communicability:
 High risk contacts – that had the following types of contact with the case during the period
of communicability: face-to-face contact > 5 minutes; shared the same confined air space for
> 1 hour; or direct contact with respiratory secretions of the infected person:
o Infants < 1 year of age
rd
o Pregnant women in the 3 trimester
o All household or family daycare contacts IF there is an infant < 1 year of age or
rd
pregnant woman in 3 trimester in household or daycare
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section IS1500 – Pertussis
Page 2
3.0
4.0
2.1
Mode of transmission
 Transmitted from an infected person to susceptible persons, primarily through
aerosolized droplets of respiratory secretions or by direct contact with respiratory
secretions from the infected person
2.2
Incubation period
 Averages 7 – 10 days (range: 5 – 21 days)
 The infectious period is reduced to 5 days after the start of antibiotics
2.3
Period of communicability
 Extends from the beginning of the catarrhal stage (one to two weeks before the onset of
paroxysmal coughing) to three weeks after the onset of the paroxysmal cough
2.4
Diagnostic testing
 Bacterial detection in nasopharyngeal swab
GUIDING PRINCIPLES
3.1
Follow BCCDC guidelines regarding chemoprophylaxis for contacts.
3.2
Chemoprophylaxis should be started as soon as possible - it may prevent contacts from
developing disease when it is given to contacts no later than 21 days after the contact's first
exposure to the case during the time the case was infectious.
3.3
Immunization following recent exposure is not effective against infection but will provide
protection if subsequent exposure occurs.
3.4
Exclusion of contacts from any setting is not indicated.
3.5
During community outbreaks, notification will be sent out to Infection Control Practitioners
(ICPs) by the CD Unit/MHO; ICPs will then notify hospital emergency rooms to heighten
awareness of potential pertussis cases.
PROCEDURE
4.1
Additional Precautions
 Confirmed or suspect cases must be placed on Droplet Precautions – do not await
laboratory confirmation of the case
4.2
Discontinuing Precautions
 Until 5 days of appropriate antimicrobial therapy received
 3 weeks after onset of paroxysms if not treated
4.3
Reporting requirements for patients seen in hospital including Emergency
rd
 Report high risk contacts, including infants < 1 year old and pregnant women in their 3
trimester, of all lab-confirmed or probable pertussis cases to the CD Unit (1-866-7787736) Monday to Friday 0830-1630 or the Medical Health Office On-Call (1-866-4575648) after hours
 Notify ICP and Infection Prevention & Control (IPAC) Medical Director or designate; ICP
will complete Communicable Disease Notification Tool
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section IS1500 – Pertussis
Page 3
4.4
5.0
Management of Pertussis Case and Contacts
 CD Unit will notify ICP if they are aware of any high risk contacts (including infants < 1
year of age or pregnant women in the 3rd trimester) and/or if the pertussis case is
admitted to hospital
 Patient admitted to hospital including Emergency Department:
o Contact tracing for admitted patient contacts done by ICP using Insight Contact
Tracing Report and reviewed with the IPAC Medical Director or designate - MHO
consulted at the discretion of IPAC Medical Director or designate
o If necessary, ICP will utilize a multidisciplinary team to determine management
of patient case and contacts; team consists of Medical Health Officer (MHO),
IPAC Medical Director or designate, ICP, nursing unit manager and others as
required
o Follow up of community contacts provided by MHO/CD Unit
o Follow up of staff contacts provided by Workplace Health and Safety (WH&S)
o Follow up of the index patient (if still admitted) and patient contacts who
remain hospitalized will be done by the Most Responsible Physician under the
direction of the IPAC Medical Director and CD Unit as required
 Patient Discharged from Emergency Department when Pertussis result becomes
available:
o ICP will complete the Communicable Disease Notification Tool
o Follow up of index patient and community contacts provided by MHO/CD
Unit
o Follow up of staff contacts provided by WH&S
o Contact tracing for admitted patient contacts done by ICP using Insight Contact
Tracing Report and reviewed with the IPAC Medical Director or designate - MHO
consulted at the discretion of IPAC Medical Director or designate
o Follow up of patient contacts who remain hospitalized will be done by the
Most Responsible Physician under the direction of the IPAC Medical Director
REFERENCES
5.1
BC Centre for Disease Control Communicable Disease Control Manual – Pertussis;
June 2010.
http://www.bccdc.ca/NR/rdonlyres/FEC42ABA-A725-4AD4-AE08893234733BEA/0/EPI_Guideline_CDChapt1Pertussis_20100625.pdf
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0100 (Surveillance for Healthcare Associated Infections)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IV0100:
Surveillance for Healthcare
Associated Infections
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
REVIEWED DATE:
1.0
PURPOSE
To reduce the occurrence of healthcare associated infections across the continuum of care (acute,
residential, community) and monitor the effectiveness of the infection prevention and control program.
2.0
DEFINITIONS
Community-Acquired Infections – infections present or incubating at the time of admission and with no
association to a recent hospitalization.
Denominator – the population at risk of acquiring a specific infection.
Device-associated Infection Rates – a rate of infection associated with exposure to a medical device,
such as a ventilator, central venous catheter or indwelling urinary catheter.
Epidemiology – the study of the frequency, distribution, cause and control of disease in populations that
forms the background for interventions to reduce transmission of infecting organisms, reduce the number
of HAIs and protect healthcare providers from infection.
Healthcare Associated Infections (HAIs) – infections that are not present or incubating at the time of
admission to the facility or program but are associated with admission to or a procedure performed in a
healthcare facility or program.
Surveillance – the comprehensive ongoing systematic collection, analysis and interpretation of outcomespecific data for use in planning, implementing and evaluating healthcare practices closely integrated
with the timely dissemination of this data to those who need it
3.0 GUIDING PRINCIPLES
3.1 Surveillance activities identify risk factors for infection and other adverse events, implementation of
risk reduction strategies and monitor the effectiveness of the interventions.
3.2 HAIs are a major and continuing challenge in hospitals and residential care homes. It is estimated
that 220,000 infections are acquired in hospitals each year in Canada, resulting in 8,000 deaths.
3.3 It is estimated that between 30% and 50% of HAIs are preventable. Therefore, an infection
prevention and control program that is effective in preventing HAIs can substantially reduce
healthcare costs and, more importantly, the morbidity and mortality associated with HAIs. The
ultimate goal of surveillance is to have zero HAIs (while recognizing that not all HAIs are
preventable).
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0100 (Surveillance for Healthcare Associated Infections)
Page 2
3.4 The use of surveillance data does not only measure clinical outcomes such as infections, but also
guides performance improvement activities and demonstrates improvements in both clinical
outcomes and healthcare practices.
3.5 HAIs are expressed as a rate, (e.g.) the number of persons at risk over a particular period of time.
Three elements are required to generate these HAI rates:

the number of cases (i.e. persons developing a particular infection);

the number of persons at risk (i.e. population at risk for development of that infection);

the time period involved.
3.6 It is a recommended practice to adjust rates of HAIs for patient length of stay by using the number of
patient days as the denominator, rather than number of admissions or number of beds.
3.7 It is a recommended best practice to calculate rates of device associated infection that are adjusted
for duration of exposure to the device.
4.0 PROCEDURE
4.1 Surveillance for HAIs is an Interior Health wide program that is carried out by trained infection
prevention and control practitioners (ICP).
4.2 A computerized surveillance system is in place to track potential infection cases across the
continuum of care. In Acute Care settings, the system identifies potential infection cases based
on predetermined HAI case definitions.
REFER TO IV0200 – DEFINITIONS FOR HEALTHCARE ASSOCIATED INFECTIONS
4.3 In Residential and Community Care settings, ICPs collect data based on predetermined HAI case
definitions and enter the data into the computerized surveillance program.
REFER TO IV0200 – DEFINITIONS FOR HEALTHCARE ASSOCIATED INFECTIONS
4.4 Standardized electronic reports are generated on a regular basis and reviewed at site specific and
corporate Infection Control Committees. Analysis and interpretation of infection data may be
done with the facility’s Infection Prevention and Control Committee or other advisory body to the
Infection Control Team. Information is also disseminated to additional stakeholders with the
ability to change infection prevention and control practice.
5.0 REFERENCES
5.1
APIC Text 2009
5.2
Best Practices for Surveillance of Healthcare Associated Infections in Patient and
Resident Populations. Provincial Infectious Diseases Advisory Committee (PIDAC), Ontario;
October 2011.
5.3
CDC/NHSN surveillance definition of health care–associated infection and criteria for specific
types of infections in the acute care setting; American Journal of Infection Control; 2008.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0200 (Definitions for Healthcare Associated Infections)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
EFFECTIVE DATE: September 2006
IV0200:
Definitions for Healthcare
Associated Infections
REVISED DATE: November 2010
December 2012, July 2014
REVIEWED DATE:
1.0
PURPOSE
Using standardized case definitions for Healthcare Associated Infections (HAI) provides opportunity
for generating surveillance data that can be compared to or pooled with other similar facilities and
settings using the same case definitions with the intent to improve patient outcomes.
2.0
DEFINITION
Case definitions for Acute Care – standardized definitions for each HAI based on the CDC/NHSN
(National Healthcare Safety Network) definitions and the Provincial Infection Control Network
(PICNet) of British Columbia definitions and allows for comparability of findings and benchmarking
with other similar hospitals.
Catheter
Case definitions for Residential Care – standardized definitions for each HAI that have been
developed based on The McGeer Criteria in addition to consensus opinions from infectious disease
physicians, epidemiologists, infection prevention and control professionals, geriatricians and public
health officials and is specifically aimed at persons living in Residential Care facilities.
Device-associated Infection Rates – a rate of infection associated with exposure to a medical
device, such as a ventilator, central venous catheter or indwelling urinary catheter.
3.0
GUIDING PRINCIPLES
3.1
To establish priorities for an HAI surveillance system, consideration must be taken for the
types of patients/residents that it serves, the key medical interventions and procedures that
they undergo and the types of infections for which they are most at risk for.
3.2
When defining HAIs, consider the frequency of the infection, the impact of the infection
(including case fatality and excess costs associated with the infection) and the preventability
of the infection. The outcomes selected for surveillance should be re-evaluated at least
annually.
3.3
Syndromic surveillance of respiratory infections and gastrointestinal infections should be
undertaken in all hospitals and residential care facilities.
3.4
In Acute Care when a particular infection meets a case definition, it should only be
considered health care associated if:
 It was not present or incubating when the patient was admitted to the hospital;
 The infection does not represent a complication or extension of an infectious process that
was present at admission;
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0200 (Definitions for Healthcare Associated Infections)
Page 2

3.5
4.0
The infection occurred more than 48 to 72 hours after admission, and within 10 days
following discharge or longer if it is related to a surgical procedure, a Clostridium difficile
infection or an antibiotic resistant organism.
In Residential Care, in order for an infection to be considered healthcare associated
 There must be no evidence that the infection was present on admission to the facility or
readmission (following hospitalization or community visit);
 There must be no evidence that the infection resulted from a procedure performed at an
acute care hospital or in a physician’s office;
 Where residents regularly attend day programs or other activities in the community and
there is uncertainty about whether the infection occurred in community or the residential
care home, the case should be counted as an HAI.
PROCEDURE
4.1
Surgical Site Infections (SSIs) Definitions
An infection involving the surgical site within 30 days of the procedure, or within 90 days
(previously 365) if an implant is in place and the infection is related to the operative
procedure. There are 3 categories of SSIs:
4.1.1
Superficial Incisional Infection – occurs within 30 days of procedure and involves
only skin and subcutaneous tissue of incision.
Patient has at least 1 of the following:
1. Purulent drainage from superficial incision
2. Organisms isolated from aseptically-obtained culture of fluid or tissue from
superficial incision
3. Superficial incision that is deliberately opened by a surgeon and is culturepositive or not cultured. (A culture negative finding does not meet criterion.)
AND Patient has at least 1 of the following S&S: - Pain or tenderness Localized swelling - redness – heat
4. Diagnosis of SSI by surgeon or attending MD
4.1.2
Deep Incisional Infection - occurs within 30 or 90 days of surgery and has implant if
after the 30 days and involves deep soft tissues of incision (i.e. fascial and muscle
layers)
Patient has at least 1 of the following:
1. Purulent drainage from deep incision
2. Deep incision that spontaneously dehisces or deliberately opened by
surgeon & is culture positive or not cultured. (A culture negative finding does
not meet criterion.) AND patient has at least 1 of the following S&S: - fever
(>38°C) - localized pain or tenderness
3. Abscess or other evidence of infection involving deep incision found on direct
exam, during invasive procedure, or by histopathologic exam or imaging test
4. Diagnosis of SSI by surgeon or attending MD
4.1.3
Organ/Space Surgical Site Infection - occurs within 30 or 90 days of surgery
& has implant if after the 30 days & involves any part of the body excluding the skin
incision, fascia or muscle layers, that is opened or manipulated during the operative
procedure
Patient has at least 1 of the following:
1. Purulent drainage from drain that is placed into the organ/space
2. Organism isolated from an aseptically-obtained culture of fluid or tissue in the
organ/space
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0200 (Definitions for Healthcare Associated Infections)
Page 3
3. Abscess or other evidence of infection involving organ/space found on direct
exam, during invasive procedure, or by histopathologic exam or imaging test
4. Diagnosis of SSI by surgeon or attending MD
4.2
Clostridium difficile Infection (CDI) Definition
The presence of diarrhea or toxic megacolon AND positive CDI result OR diagnosis of
pseudo-membranous colitis OR histological/pathological diagnosis of CDI with or without
diarrhea And the following:
4.2.1
Criteria for New CDI Associated with YOUR Facility
1. Symptoms onset > 72 hours after admission OR
2. Symptoms onset in the community or occurring ≤ 72 hours after admission
AND - Pt was admitted for a period of at least overnight (≥24 hours) in the
past 4 weeks before hospitalization AND - Symptoms onset was less than 4
weeks after the last discharge from your facility
4.2.2
Criteria for New CDI associated with OTHER Healthcare Facility
1. Symptoms onset in community or occurring ≤ 72 hours after admission to
your facility AND
Pt was admitted to another healthcare facility (including acute/ LTC) for at
least overnight (or ≥24 hours) in past 4 weeks before current hospitalization
AND
Symptom onset was less than 4 weeks after discharge from that facility with
another facility
4.2.3
Relapse of CDI
 A CDI case (as defined above) with recurrence of diarrhea between 2 – 8
weeks after previous CDI case
 CDI identified less than 2 weeks after previous episode is considered to be a
continuation of previous CDI case
4.2.4
Community Associated
 A CDI case (as defined above) with symptom onset in the community or ≤ 72
hours after admission to a healthcare facility, provided the patient was not
admitted to any healthcare facility (including acute care and long-term care)
for ≥ 24 hours in the past 4 weeks before onset of CDI symptoms
4.3
Antibiotic Resistant Organisms (AROs) Definition
AROs include Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant
Enterococcus (VRE), Extended Spectrum Beta-lactamase (ESBL)
4.3.1
Criteria for Healthcare associated with current admission to Your Facility
1. Not previously positive for ARO AND
Identified > 48 hours after patient admitted to your facility Or Newborn
4.3.2
Criteria for Healthcare associated with previous encounter with Your
Facility
Not previously positive for ARO AND identified ≥48 hours after admission and meets
one criteria:
1. Admitted to your facility at least over night (≥24 hours) within the last 12
months OR
2. Indwelling catheters or medical device at time of admission, which was
inserted by your facility OR
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0200 (Definitions for Healthcare Associated Infections)
Page 4
3. Documented weekly visits to outpatient clinic (i.e. dialysis, oncology) in your
facility in the last 12 months
4.3.3
Criteria for Healthcare associated with Another Facility
Not previously positive for ARO AND identified ≤ 48 hours after admission and meets
one criteria:
1. Any contact with another healthcare facility as inpatient (acute/LTC) or as
outpatient (dialysis/oncology) within the last 12 months OR
2. Indwelling catheters or medical device at time of admission, which was
inserted by another facility
4.3.4
Community Associated
Any case without documented history of healthcare exposure including admission to
acute care, LTC or rehab, weekly visits to an outpatient clinic (dialysis, oncology, i.e.
use of indwelling catheter or other medical device)
Newborn: Less than 28 days considered case for Your Facility if the mother was not
known or suspected to be ARO positive on admission. In the case of a newborn
transferred from another facility and ARO identified ≤ 48 hours after admission the case
is classified as healthcare associated with Another Facility
Multiple Encounters: If a patient has multiple encounters with different healthcare
facilities in the last 12 months the classification of ARO will be based on the most recent
encounter
4.4
Ventilator Associated Pneumonia (VAP) – includes the classifications of both Possible and
Probable VAPs
 On a ventilator ≥ 3 days and > 14 days since last Ventilator Associated Condition (VAC)
(VAC - After a period of stability or improvement of 2 or more days, requires one of
the following: 1. Increase FIO2 of ≥ 20 points for ≥ 2 days
2. Increase in PEEP ≥ 3cm for ≥ 2 days)
 Within window period (2 days before + 2 days after VAC date – 5 days total) meets
BOTH Criteria:
1. Has a temp>38 ̊ C or <36 ͦ C OR white blood cell count ≥12.0 x 10⁹/l or 4.0 x 10⁹/l
AND
2. A new antimicrobial agent(s) is started and continued for ≥ 4 days
AND
 Within window period meets ONE of the following criteria:
1. Purulent respiratory secretions (1 or more specimens) defined as gram stain of
4+ WBC & 1 to 2+ epithelial cells
2. Positive culture of sputum endotracheal aspirate, BAL, lung tissue or protected
specimen brushing
AND
the organism is NOT excluded: “Normal respiratory flora,” “normal oral
flora,” mixed respiratory flora,” “mixed oral flora,” “altered oral flora” or
other commensal flora of the oral cavity or upper respiratory tract:
Candida species or yeast not otherwise specified; coagulase-negative
Staphylococcus species; and Enterococcus species, when isolated from
cultures of sputum, endotracheal aspirates, bronchoalveolar lavage, or
protected specimen brushings
OR
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0200 (Definitions for Healthcare Associated Infections)
Page 5
Excluded organisms isolated from cultures of lung tissue or pleural fluid
including Candida species or yeast not otherwise specified, coagulasenegative Staphylococcus species or Enterococcus species
OR
Test result meets one of the following criteria:
-
Positive pleural fluid culture (from thoracentesis or initial placement of chest
tube)
OR Positive lung histopathology
OR Positive diagnostic test for legionella spp
OR Positive diagnostic test for respiratory viruses
4.5
Central Line Associated Bloodstream Infection (CLABSI) Definition – surveillance
restricted to Intensive Care Unit (ICU) patients who:
 Have a central line in place > 2 calendar days OR central line has been discontinued
for < 3 calendar days AND
 There is a pathogen in 1 or more blood cultures AND infection is not suspected at
another site AND all elements of lab confirmed blood stream infection first present
together on or after the 3rd hospital day AND
 Patient has at least 1 of the following : -- Fever >38°C -- OR chills -- OR
hypotension (systolic <90) AND positive lab results that are not related to an infection
at another site AND common commensal is cultured from 2 or more blood cultures,
drawn on separate occasions AND criteria elements occurred within a timeframe that
does not exceed a gap of 1 calendar day AND all elements of lab confirmed blood
stream infection first present together on or after the 3rd hospital day
 Central line: An intravascular catheter that terminates at or close to the heart or in
one of the great vessels and is used for infusion, withdrawal of blood, or
hemodynamic monitoring.
 PICC line: a peripherally inserted central catheter is inserted in a peripheral vein and
then advanced through increasingly larger veins toward the heart until the tip rests in
the distal superior vena cava, is considered a central line.
 Non-lumened devices inserted into central blood vessels or the heart (i.e.
pacemaker) are not considered central lines if fluids are not infused, pushed or
withdrawn through the device.
4.6
Lower Respiratory Tract Infection (LRI) / Pneumonia Definition in Residential Care
Review chart to rule out other conditions that could account for symptoms (CHF, COPD)
For an LRI:
Are there TWO or more Signs & Symptoms:
 new or increased cough
 new or increased sputum production
 oxygen saturation < 94% or <3% from baseline
 abnormal lung exam new or changed
 pleuritic chest pain
 respiratory rate > 25 breaths/min
AND
 Is there 1 or more constitutional criteria: fever, leukocytosis, confusion or
functional decline?
For a Pneumonia:
Does the chest x-ray indicate pneumonia?
AND
Are there ONE or more Signs & Symptoms:
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0200 (Definitions for Healthcare Associated Infections)
Page 6
 new or increased cough
 new or increased sputum production
 oxygen saturation < 94% or <3% from baseline
 abnormal lung exam new or changed
 pleuritic chest pain
 respiratory rate > 25 breaths/min
AND
Is there 1 or more constitutional criteria: fever, leukocytosis, confusion or functional
decline?
4.7
Skin & Soft Tissue Infection (SSTI) Definition in Residential Care
Criteria: Must have ONE of the following:
 Pus present at a wound, skin, or soft tissue site OR
 Are there FOUR or more signs and symptoms:
serous drainage at site
site swelling
heat at site
site tenderness or pain
site redness
one constitutional criteria : fever, leukocytosis, confusion, acute functional
decline?
 Was the wound secondary to an injury?
4.8
Catheter Associated Urinary Tract Infection (CAUTI) in Residential Care
Criteria: Resident must have indwelling urinary catheter and at least ONE of the following:
 Fevers, rigors OR new onset hypotension with NO alternate sign of infection
 Acute change in mental status OR functional decline with no alternate diagnosis
AND leukocytosis (WBC > 14,000)
 New onset suprapubic pain or costoverterbral angle pain or tenderness
 purulent discharge around catheter or acute pain, swelling of testes, epididymis or
prostate
AND
 Urine culture (> 10⁶ CFU/ml) correlates with symptoms
OR
 Positive blood culture & urine culture with same organism with no alternate site of
infection
 Fever (>38C) or chills, new flank or supra-pubic pain or tenderness, change in
character of infection
5.0
REFERENCES
5.1.
CDI Surveillance Protocol – Provincial Infection Control Network (PICNet) BC, June 2014.
5.2.
MRSA Surveillance Protocol – Provincial Infection Control Network (PICNet) BC, June
2014.
5.3.
CDC/NHSN surveillance definition of healthcare associated infection and criteria for
specific types of infections in the acute care setting; 2013.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0200 (Definitions for Healthcare Associated Infections)
Page 7
5.4.
Stone, Nimalie D. et. al. Surveillance Definitions of Infections in Long-Term Care
Facilities; Revisiting the McGeer Criteria. Infection Control and Hospital Epidemiology,
Vol. 33, No. 10 (October 2012), pp. 965-977.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0300 (Surgical Site Infections -SSIs)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IV0300:
Surgical Site Infections (SSIs)
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010, July 2014
June 2016
REVIEWED DATE:
1.0
PURPOSE
To identify the potential risks associated with surgical procedures and Surgical Site Infections (SSIs)
and include this information in the risk stratification and data analysis of SSIs with the intent to
improve patient outcomes.
2.0
DEFINITIONS
SSIs – Surgical Site Infections occur as a complex interaction between the microbial contamination
of the surgical site, the host response, and the local environment at the site of contamination. An SSI
is generally considered to be present when purulent drainage is identified at the surgical site. SSI
rates are the percentage of surgical operative sites that are infected and are usually stratified based
on the Surgical Wound Classification.
Surgical Wound Classification – a system of categorizing surgical procedures into risk groups
based on the likelihood of contamination of the surgical site at the time of the operative procedure.
Each operative wound is assessed and categorized as per the classes noted below
and is to be done upon completion of the surgery in consultation with the surgeon.
If a change in wound classification occurs, the reason must be documented on the OR Case Record
(i.e. gross break in technique, glove perforation, etc.).
The four classes of wounds include:
Clean Wounds (Class I) – uninfected operative wound in which no inflammation is encountered,
involve access only to the sterile body sites and carry the lowest risk (e.g. less than 5%) of surgical
site infection. Clean wounds are primarily closed and, if necessary, drained with closed drainage.
Operative incision wounds that follow non-penetrating (blunt) trauma should be included in this
category if they meet the criteria. There is no break in sterile technique
Clean-Contaminated Wounds (Class II) – an operative wound in which the respiratory, alimentary,
genital or urinary tracts are entered under controlled conditions and without unusual contamination.
A minor break in surgical sterile technique in an otherwise clean procedure would fit into this class.
Operations involving the biliary tract, appendix, vagina, and oropharynx are included in this category,
provided no evidence of infection or major break in technique is encountered.
Contaminated Wounds (Class III) – carry a high risk (e.g. 10 to 15%) of infection often because
they involve unusual contamination from a non-sterile site. Examples include:
 Open, fresh, accidental wounds less than 8 hours old from a relatively clean source
 Gross spillage from the gastrointestinal tract
 Incisions in which acute, non-purulent inflammation is encountered
 Acute inflammation seen – without frank pus
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0300 (Surgical Site Infections -SSIs)
Page 2


The GU or biliary tracts are entered in the presence of infected bile or urine
Operations with major breaks in sterile technique
 Examples of major breaks in sterile technique include: open cardiac massage, gross
spillage from the GI tract, use of unsterile instruments, drapes or supplies,
perspiration in the wound, unsterile foreign bodies in the wound, and insects in the
OR suite.
Dirty or Infected Wounds (Class IV) – Old traumatic wounds (over 12 hours) with retained
devitalized tissue or wounds where there is an existing clinical infection or perforated viscera or
fecal contamination.
Surgical Site Infection surveillance definitions include the following:
Superficial Incisional Infection – occurs within 30 days of procedure and involves only skin and
subcutaneous tissue of incision.
Patient has at least 1 of the following:
1. Purulent drainage from superficial incision
2. Organisms isolated from aseptically-obtained culture of fluid or tissue from superficial
incision
3. Superficial incision that is deliberately opened by a surgeon and is culture-positive or not
cultured. (A culture negative finding does not meet criterion.) AND Patient has at least 1
of the following S&S: - pain or tenderness - localized swelling - redness - heat
4. Diagnosis of SSI by surgeon or attending MD
Deep Incisional Infection – [occurs within 30 or 90 days of surgery and has implant if after the 30
days] and involves deep soft tissues of incision (i.e. fascial and muscle layers)
Patient has at least 1 of the following:
1. Purulent drainage from deep incision
2. Deep incision that spontaneously dehisces or deliberately opened by surgeon & is culture
positive or not cultured. (A culture negative finding does not meet criterion.) AND Patient
has at least 1 of the following S&S: - fever (>38°C) - localized pain or tenderness
3. Abscess or other evidence of infection involving deep incision found on direct exam,
during invasive procedure, or by histopathologic exam or imaging test
4. Diagnosis of SSI by surgeon or attending MD
Organ/Space Surgical Site Infection – [occurs within 30 or 90 days of surgery and has
implant if after the 30 days] & involves any part of the body excluding the skin incision, fascia
or muscle layers, that is opened or manipulated during the operative procedure
Patient has at least 1 of the following:
1. Purulent drainage from drain that is placed into the organ/space
2. Organism isolated from an aseptically-obtained culture of fluid or tissue in the
organ/space
3. Abscess or other evidence of infection involving organ/space found on direct exam,
during invasive procedure, or by histopathologic exam or imaging test
4. Diagnosis of SSI by surgeon or attending MD
3.0
GUIDING PRINCIPLES
3.1
SSIs remain a substantial cause of morbidity and an associated mortality rate of 3% has
been attributed to them. Most SSIs are caused by the host’s own endogenous flora. The
Centres for Disease Control and Prevention (CDC) estimates that 2.7% of surgical
procedures are complicated by SSIs which translates into an extra hospital stay of
approximately 6.5 days for each SSI.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0300 (Surgical Site Infections -SSIs)
Page 3
3.2
4.0
Prevention of SSIs consists of:
 Minimizing access of bacteria to the surgical site through the use of antiseptic scrubs,
skin prep procedures, sterile barriers used during operative procedure, environmental
controls and prophylactic antibiotics.
 Enhancement of the Host during the operative procedure through administration of
supplemental oxygen and prevention of hypothermia and hyperglycemia.
 Delayed Primary/Secondary Closure is a viable option for massive disruptions of the
colon (e.g.) gunshot wound or pancreatic abscess.
PROCEDURE
Classification of Surgical Procedures is done by the Operating Room staff
Decision Tree – All procedures except C-sections
Decision Tree C-sections
5.0
REFERENCES
5.1
CDC/NHSN surveillance definition of healthcare associated infection and criteria for
specific types of infections in the acute care setting; 2013.
5.2
CDC/NHSN surgical site infection event; 2013.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0400 (Gastrointestinal Outbreak Guidelines)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IV0400:
Gastrointestinal Outbreak
Guidelines
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
December 2014, October 2015
REVIEWED DATE:
1.0
PURPOSE
This guideline has been developed in collaboration with the Communicable Disease (CD) Unit and
provides guidance for healthcare facilities when a Gastrointestinal Outbreak is suspected.
To link to the Communicable Disease Gastrointestinal Infection Outbreak in Health Care Facilities
Toolkit
I.H. FACILITY
GASTROINTESTINAL INFECTION OUTBREAK GUIDELINES
QUICK REFERENCE: GI OUTBREAK
GI OUTBREAK SURVEILLANCE TOOL
NON I.H. FACILITY
GI OUTBREAK GUIDELINES
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0500 (Respiratory Infection (RI) Outbreak Guidelines)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IV0500:
Respiratory Infection (RI) Outbreak
Guidelines
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
December 2012, September 2014, October
2015
REVIEWED DATE:
1.0
PURPOSE
This guideline has been developed in collaboration with the Communicable Disease (CD) Unit and
provides guidance for healthcare facilities when a Respiratory Infection Outbreak is suspected.
To link to the Communicable Disease Respiratory Outbreaks in Residential Care Settings Toolkit.
I.H. FACILITY
RESPIRATORY INFECTION OUTBREAK GUIDELINES
QUICK REFERENCE: RI OUTBREAK
RI OUTBREAK SURVEILLANCE TOOL
NON I.H. FACILITY
RI OUTBREAK GUIDELINES
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0600 (Communicable Diseases in Employees)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IV0600:
Communicable Diseases in
Employees
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010,
December 2012
REVIEWED DATE:
1.0
PURPOSE
To provide guidance in the prevention and management of healthcare provider exposures to and
infections with infectious diseases in the work place.
2.0
DEFINITIONS
Exposure – may occur when a healthcare provider is in direct or indirect contact with patient or coworker who has a known or suspected infection with a communicable disease. This contact may
occur through, but is not limited to, needle-stick, injuries, splashes, airborne droplets, contact with
nasal or throat secretions or close contact during examinations/treatment.
Healthcare Provider – includes Interior Health staff, physicians, students, volunteers, and all
persons who work within the Interior Health facilities.
Risk Assessment – healthcare providers are at risk of exposure to communicable diseases because
of their contact with patients or material from patients with infections both diagnosed and
undiagnosed. Use of immunization agents assists in protecting patients and healthcare providers
from becoming infected.
3.0
GUIDING PRINCIPLES – Refer to AV0900 – Prevention and Management of Occupational Exposure
to Communicable Diseases:
AV0900 – Prevention and Management of Occupational Exposure to Communicable Diseases
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0600 (Communicable Diseases in Employees)
Page 2
PROCEDURE
4.19
EMPLOYEE WORK RESTRICTIONS WITH COMMUNICABLE DISEASES
Employees may not work in the healthcare environment during the known period of communicability
for:
Chickenpox (Varicella
Until all lesions are dried and crusted and no new lesions are forming.
zoster)
Diarrhea/Vomiting
Until 48 hours after symptoms have resolved.
Influenza
Restrict until 5 days after symptoms began or until symptoms have resolved
whichever is longer.
Measles (Rubeola)
Until 4 days after rash appears, or duration of illness in Immunodeficient
individuals.
Mumps
For 9 days after onset of swelling; less if swelling has subsided.
Parvovirus B19 (fifth’s
disease)
No restriction but pregnant workers are not to care for children with Parvovirus
and aplastic crisis or immunosuppressed patients with chronic Parvo infection
and anemia.
Pertussis
Restrict until 3 week after onset of paroxysmal cough or 5 days of appropriate
treatment is completed.
rd
Rubella (German
measles)
Scabies or Pediculosis
Until 5 days after rash appears.
Until 24 hours after initiation of appropriate treatment.
Shingles (Herpes zoster)
Patient contact is limited to immune patients and lesions are covered.
Tuberculosis
Until receiving appropriate therapy and clinical improvement. The employees
physician shall review the case prior to allowing the employee to return to work.
Employees may or may
not require work
restrictions due to
specific acute
infections or carrier
states.
Group A Streptococcus or
Staphylococcus
No restriction unless clearly associated with disease transmission.
Acute hepatitis B, or
HBsAg positive
Acute hepatitis C
HIV positive or AIDS
Individual evaluation by Employee Health. Work restriction will depend upon the
employee's hygiene and preventing his/her blood and other body fluids from
contacting others.
Neisseria meningitidis
(meningococcus)
No restriction or treatment for carrier state required; for acute meningococcal
disease, including meningitis, employees would be too ill to work.
Amebiasis, Salmonella,
Campylobacter, Shigella,
Cholera,
Worms/Parasites
Hepatitis A
Food handlers are restricted. In other healthcare providers, evaluation by
Employee Health is necessary.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0600 (Communicable Diseases in Employees)
Page 3
Employees must be evaluated by Employee Health or their private physician regarding their work area
if they have certain signs or symptoms of the following conditions:
Draining abscesses, boils
Exudative dermatitis
Herpes simplex (whitlow, stomatitis)
Uncontrolled respiratory symptoms/infections
Impetigo
Conjunctivitis
See Workplace Health & Safety
4.2 SUSCEPTIBLE EMPLOYEES
Exposure of susceptible employees to specific communicable diseases may require restriction from
work during the incubation period, for example:
Chickenpox, Varicella
Incubation period is 10-21 days after exposure; restriction would be
from day 8 after first exposure thru day 21 after last exposure (up to
28 days if given VZIG varicella zoster immune globulin) or, if
disease develops, until the last crop of vesicles is dried and
crusted.
Measles, Rubeola
Incubation period is 7-18 days; restriction would be, as per BCCDC
Communicable Disease Manual update March 2010, from day 5
after first exposure to day 21 after last exposure; if disease
develops, until 4 days after onset of rash. Live vaccine given to
susceptibles within 72 hours of exposure may prevent illness.
Mumps
Incubation period is about 16 to 18 days: restriction would be from
12 until 25 days after exposure; if disease develops, for 9 days
after onset of parotid gland swelling, but less if swelling has
subsided. Immunization of susceptible persons following exposure
is of uncertain value.
Rubella
Incubation period is 14-21 days; restriction would be from day 7
after exposure through day 23; if disease develops, until 4 days
after rash appears.
4.3
Occupational Exposure to a Communicable Disease
Infection Control Practitioner will complete the Communicable Disease Notification Tool
and forward it to the CD Unit and IH Occupational Health.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 09V - IV0600 (Communicable Diseases in Employees)
Page 4
5.0
REFERENCES
5.1
Prevention and Control of Occupational Infections in Healthcare. Public Health
Agency of Canada (PHAC); March 2002.
5.2
Guidelines for Infection Control in Healthcare Professionals. Bolyard EA,
Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deithman SD. AJIC (American
Journal of Infection Control), vol. 1998;26(3):289-354
5.3
Control of Communicable Diseases Manual. 19th Edition. David L. Heymann
(2008).Published American Public Health Association, WA DC
5.4
AV0900 - PREVENTION AND MANAGEMENT OF OCCUPATIONAL EXPOSURE TO
COMMUNICABLE DISEASES; IH Administrative Policy Manual – AV Workplace Health and
Safety; December 2009.
5.5
BCCDC Communicable Disease Manual.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0100 (Microbiology Specimen Collection)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
IX0100:
Microbiology Specimen Collection
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010, June 2016
REVIEWED DATE: February 2015
located on IHNET at the Policies & Procedures Home Page
1.0
PURPOSE
This information is now available on the Microbiology website
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0200 (Prevention & Control of Catheter Associated Urinary Tract
Infections -CAUTI)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX0200:
Prevention & Control of Catheter
Associated Urinary Tract Infections (CAUTI)
1.0
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
February 2015, June 2016
REVIEWED DATE:
PURPOSE
This information is now available in the Urinary Catheters toolkit.
This information will not be available to anyone outside of Interior Health.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX0300 (Pneumococcal Vaccine for Residential Care)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX0300:
Pneumococcal Vaccine for
Residential Care
EFFECTIVE DATE: June 2009
REVISED DATE: November 2010,
December 2012
REVIEWED DATE:
1.0
PURPOSE:
All persons being admitted to an Extended or Intermediate Care Facility are to be assessed for their
status of having received a pneumococcal vaccine in the past and this information will be recorded on
the resident’s chart. If they have not had a pneumococcal vaccine, they will be offered the vaccine
upon admission to the facility and this information will be recorded on the resident’s chart.
2.0
3.0
GUIDING PRINCIPLES:
2.1
Streptococcus pneumoniae (pneumococcus) can cause serious invasive disease including
bacteremia, meningitis and pneumonia in people with high-risk medical conditions and the
elderly. Pneumococcal infection is spread by droplet/contact from one person to another by
coughing, sneezing, close face-to-face contact and direct contact through saliva.
2.2
The pneumococcal polysaccharide vaccine is offered free to seniors 65 years and older and
to persons 2 years of age and older with certain medical conditions including those who have
no spleen or a spleen that is not functioning properly*, sickle-cell disease*, immune systems
weakened by disease or medical treatment*, chronic liver disease including cirrhosis*,
chronic hepatitis B or hepatitis C*, chronic kidney disease*, chronic heart or lung disease,
transplant patients, diabetes, cystic fibrosis, chronic cerebrospinal fluid leak, cochlear implant
candidate or recipient, alcohol dependency, homelessness and/or illicit drug use.* People in
these groups should receive a second dose of vaccine five years after the first dose and this
requires a physician order.
2.3
Residents of any age living in residential care are considered an at risk population for
suffering complications from pneumococcal disease and should receive the vaccine upon
admission to the facility if they have not already had the vaccine previously.
2.4
Contraindications for the vaccine include anaphylaxis reaction to the vaccine or component of
the vaccine in the past. Possible reactions to the vaccine may include soreness, redness and
swelling at the site of injection. Headache and mild fever may also occur. These reactions
are mild and generally last 1 to 2 days.
PROCEDURE
3.1
All Residential Care facilities should have pre-printed physician orders for “pneumococcal
vaccine on admission if resident has not been immunized in the past”. Upon admission, staff
is to seek out and document information about the resident’s pneumococcal immunization
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX0300 (Pneumococcal Vaccine for Residential Care)
Page 2
status by asking the resident and/or family, the resident’s physician (contact office) and/or the
Public Health office. Document information according to facility guidelines.
4.0
3.2
Residents who do not have a record of pneumococcal immunization with Public Health or
their family physician require immunization by the facility – this should be done within two
weeks of admission.
3.3
Do not delay immunization if proof of prior immunization is not available within this
two week time frame - when in doubt, with no documented proof: IMMUNIZE.
3.4
It is recommended that facilities carry out yearly audits to ensure the procedure for
administering and documenting pneumococcal vaccination in Residential Care Facilities is
being implemented appropriately with the target being at least a 90% vaccination coverage
compliance rate.
REFERENCE
4.1
Public Health Agency of Canada. Seventh Edition Canadian Immunization Guide 2006.
4.2
BC Centre for Disease Control. Communicable Disease Control Immunization Program,
Section VII – Biological Products, January 2010.
4.3
Required Organizational Practices 2012. Accreditation Canada; pg 52.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0400 (Pet Therapy and Visitation)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX0400:
Pet Therapy and Visitation
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
REVIEWED DATE: February 2015
1.0
PURPOSE
The purpose of a pet therapy & visitation program is to provide patients with the positive aspects of
stimulation, motivation and cooperation that human/animal interaction can offer in the hospital
environment. This form of therapy is used successfully with people in many healthcare settings and
literature supports the position that pet therapy increases cooperation with medical treatment and
feelings of well-being while decreasing the stress of illness and hospitalization. Our target audience
includes all eligible (as defined in this guideline) patients, with an emphasis on those patients who
experience long-term hospitalization, and/or demonstrate a need for unconditional love, positive
motivation and socialization while involved in their hospital experience.
To allow visitation of appropriately screened therapy dogs and their screened and trained handlers to
eligible patients. This guideline will cover residential pets, service, guide animals and patient owned
pets as well.
2.0
DEFINITIONS
Guide dog - this term shall refer to a dog which is in working harness and is certified to guide blind or
hearing impaired persons by an accredited canine school that is engaged in this specific type of
training.
Service dog - this shall mean a dog that is certified to assist disabled people by an accredited canine
school that is engaged in this specific type of training.
Therapy dog - this shall refer to animals that are brought by specially trained professionals, paraprofessionals, and/or volunteers to provide opportunities for motivational, educational, recreational,
and/or therapeutic benefits to enhance quality of life.
Pet animal - this shall refer to any animal which belongs to a patient and whose presence in the
hospital is requested by the patient and his physician.
3.0
GUIDING PRINCIPLES
3.1
Visitation of any animals to critical care areas, rooms where Additional Precautions are being
implemented, medication or clean supply rooms, food storage or preparation areas, and
dining rooms is prohibited.
3.2
Service/guide animals care and health is the responsibility of their owners. They will be given
access to all areas in the facility except those noted in 3.1 above.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0400 (Pet Therapy and Visitation)
Page 2
3.3
Rodents, reptiles, and other exotic pets are prohibited without special permission of Infection
Control.
3.4
All pet therapy/residential animals will have an approved handler who will be responsible for
their health and well being as well as ensuring that they are in compliance with this guideline
3.5
Handlers will perform hand hygiene after all visitations. The handler will assist the patient in
performing hand hygiene prior to leaving the room.
3.6
Screened and trained pet therapy animal handlers must:
 Be individuals from agencies who will fully support these guidelines and any other
policies of IHA that may apply to or have bearing on pet therapy programs and the
general safety of our patients and families.
 Have submitted an application to and have the approval of the Volunteer Coordinator.
 Be a minimum of eighteen (18) years of age.
 Be a certified and approved member of an approved Therapy Dogs/ Pet Program.
3.7
Appropriately Screened Dogs for the pet therapy or residential program will:
 Be a minimum of one (1) year old.
 Complete the required dog history.
 Require that every animal receives a health evaluation by a licensed veterinarian at least
once per year and ensure that vaccinations are current, e.g.:
o Distemper.
o Hepatitis.
o Parainfluenza.
o Parvovirus.
o Rabies.
 Defer to the animal’s veterinarian regarding an appropriate flea, tick and enteric parasite
control program which should be designed to take into the account the risks of the animal
acquiring these parasites specific to its geographic location and living conditions.
 For the protection of both the animal and people, prevent the animal from entering the
Healthcare Facility from the onset of and until at least 1 week beyond the resolution of:
o Episodes of vomiting or diarrhea.
o Urinary or fecal incontinence.
o Episodes of sneezing or coughing of unknown or suspected infectious origin.
o Treatment with non-topical antimicrobials or with any immunosuppressive doses
of medications.
o Open wounds.
o Ear infections.
o Skin infections or ‘hot spots’ (i.e. acute moist dermatitis).
o Orthopedic or other conditions that, in the opinion of the animal’s veterinarian,
could result in pain or distress to the animal during handling and/or when
maneuvering within the facility
3.8
Dogs that do not meet screening requirements (regarding consequences for handlers not
following the above guidelines, policies or dogs that test positive for lab results):
 The documents supporting these actions will be kept on file with the hospital volunteer
coordinator and must be kept up to date. Those in non-compliance with the timely testing
of their dogs will be immediately suspended from the program.
 Dogs who test positive in the throat and/or fecal cultures will be immediately suspended
from the program.
 One positive Salmonella culture will permanently retire a dog from the program.
 A total of three positive cultures over any period of time, for any of the above stated
pathogens or parasites, will permanently retire a dog from the program.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0400 (Pet Therapy and Visitation)
Page 3


3.9
4.0
If a dog has been removed from scheduling due to a positive test that dog will not be
scheduled again until the following criteria have been met and documented:
o
For treated parasite or pathogen, a first retest will be performed no sooner than
seven (7) days following completion of the prescribed treatment. After two
consecutive negative retests (30 days apart), the dog will be able to resume
visits.
Appropriately Screened Cats/Birds for the pet therapy or residential program will:
o Be full grown animals and not juveniles.
o Complete the required history.
o Receive a yearly exam and certificate of good health with all appropriate
vaccinations.
o Have passed a standard temperament test.
o Be groomed (bathed, nails trimmed) within 24 hours prior to visitation.
o Not be in estrus (heat) when participating in therapy work.
Personal Pets
 Pet visitation will be restricted to special situations where the patient care team, doctor,
nurses and/or social workers believe such visitation will benefit the patient.
 Pets are limited to cats and dogs and must:
o Be visiting a specific patient.
o Be clean and well groomed prior to entering the facility.
o Have a veterinarian exam and certificate of health, within the past year
documenting current immunizations and being free of disease and parasites and
in good health.
o Not be aggressive, hyperactive or difficult to control.
o Be supervised and contained with leash/cage, by the designated pet handler at
all times. This supervision includes any necessary care and cleanup.
PROCEDURE
4.1
Arranging a visit:
 All visits will be approved by the attending physician.
 The supervising nurse and/or charge nurse will be notified that the animal visit is to
occur.
4.2
Appropriate patients for visits:
 Before a patient will be considered eligible for any visitation, the following requirements
must be met:
o Physician consent (by verbal or written order).
 The following patients will not be eligible for dog visitation:
o Patients on Additional Precautions due to infection.
o Patients with known immunodeficiency disorders.
o Patients with known animal allergies.
o Patients whose physician requests that their patient not receive a visit.
o Any patient or parent who expresses any concern regarding a visit will not be
included in the visit.
4.3
Animal Waste
 If animal waste occurs at anytime during the visit, the dog handler will be responsible for
immediately cleaning the area with the approved provided clean-up kit. The handler will
be provided with the following materials:
o Disposable gloves.
o Plastic bags.
o A container of a germicidal cleaning agent
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0400 (Pet Therapy and Visitation)
Page 4
(All used materials will be put in the plastic bag which will be disposed of in
an appropriate waste container.)

5.0
If an animal should develop symptoms of any illness following a hospital visit, the handler
will immediately notify the Infection Control Department.
REFERENCE
5.1
Sandra L. Lefebvre, et al. Guidelines for animals – assisted interventions in health care
facilities. AJIC American Journal of Infection Control 2008; 36:2 pp 78-85.
5.2
Routine Practices and Additional Precautions for Preventing the Transmission of Infection in
Health Care Settings; Public Health Agency of Canada; 2013, P.32.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – I X0500 (Soiled Utility Rooms)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX0500:
Soiled Utility Rooms
EFFECTIVE DATE: March 2008
REVISED DATE: November 2010
REVIEWED DATE: February 2015
1.0
PURPOSE
To minimize the risk of infection transmission in clinical areas that generate soiled equipment, soiled
linen and waste.
2.0
3.0
GUIDING PRINCIPLES
2.1.
Requirements for Soiled Utility Rooms include:
 Work counter with sink, gooseneck faucet and wrist blades.
 Separate wall-hung hand sink for hand washing with soap and towel dispensers.
 Space for waste receptacles and soiled linen receptacles; provision for storing and
transporting soiled linen in covered leak proof containers.
 Hospital approved equipment and products for cleaning and sanitizing bedpans, urinals,
and basins.
 Closed cupboards or covered bins for containing clean supplies such as bedpans,
urinals, basins, incontinence supplies, and lab supplies such as urine dipsticks, specimen
containers.
 *If closed cupboards are not available, ensure open shelves are located away from
“splash risks” around sinks, and bedpan sanitizers.
2.2.
Items that can be housed in Soiled Utility Room include:
 Cleaning supplies and products readily available for non-housekeeping staff.
 Soiled equipment, soiled laundry.
 Personal Protective Equipment to wear while cleaning items including eye protection,
surgical/procedure masks, fluid resistant apron, household gloves.
 Items to be cleaned after each use, such a commode, once cleaned, they need to be
stored elsewhere.
 General and Biohazardous waste containers.
 Specimen fridge for holding laboratory specimens.
2.3.
Items that should not be kept in a Soiled Utility room include:
 Kleenex boxes.
 Skin antiseptics/cleansers.
 Personal hygiene supplies (soaps, mouth care products, lotions).
 Sterile items such as wound dressings.
REFERENCES
3.1.
Best Practice for Environmental Cleaning for Prevention and Control of Infections in All
Healthcare Settings; Provincial Infectious Disease Advisory Committee (PIDAC), Ontario,
May 2012.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0600 (Equipment Cleaning)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX0600:
Equipment Cleaning
EFFECTIVE DATE: February 2009
REVISED DATE: November 2010
December 2012, March 2013
REVIEWED DATE:
1.0
PURPOSE:
To prevent the transmission of microorganisms from soiled equipment to patients.
Cleaning is a shared responsibility between multiple departments and healthcare providers.
2.0
DEFINITION
See the glossary in Appendix A for definitions
3.0
GENERAL PRINCIPLES
3.1
Dedicate equipment for a single patient.
3.2
Shared equipment must be cleaned and disinfected between patient uses.
3.3
Clean soiled equipment immediately – must be cleaned prior to disinfection.
3.4
Disinfectant wipes should be used for point of care cleaning and disinfection of patient
equipment; wipes must be kept wet and discarded if they become dry.
3.5
Never reuse single use equipment that is not appropriate to dedicate to single patient use
(i.e. critical equipment) – discard immediately after use.
3.6
Do NOT use tape that leaves a residue on patient equipment.
3.7
Report damaged equipment to manager for replacement.
3.8
Do NOT stockpile supplies and equipment in patient room – clutter increases the risk of cross
contamination in patient care areas (including hallways).
3.9
Personal care items (i.e. lotions, skin cleansers, razors) are single patient use and not to be
shared between patients.
3.10
Assign responsibility for routine cleaning of equipment.
3.11
Foot care equipment must be sterilized between patient use – if the equipment is assigned as
single patient use, it can be low level disinfected between use on that same patient.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 2
4.0
PROCEDURE
4.1
Wear appropriate personal protective equipment (PPE) for the task.
4.2
Clean and disinfect reusable equipment in a designated area.
 Clean small items in patient rooms prior to use on another patient.
 Transport large items to the soiled utility room for cleaning.
 Avoid performing equipment cleaning in high traffic areas like hallways or where
contact with clean items may occur (clean hallway carts).
4.3
Wipe equipment thoroughly – if cloth/wipe comes away dirty, repeat until it comes away
clean.
4.4
Allow equipment to air dry.
 Some items may require rinsing off prior to use – ensure disinfectant has adequate
contact time with the equipment/device before rinsing.
4.5
Designate a location for clean equipment (ideally, clean storage rooms or clean service
rooms) where they are transported after cleaning.
 Implement a process where the item is identified as clean, disinfected and ready for
use on another patient.
4.6
Cardboard/paper items
 Wipe laminated cardboard/paper with cloth or wipe – if not laminated, discard after
use.
4.7
Fabric items
 All fabric items used in patient care areas must be washable.
 Washing can take one of 3 forms:
o Coated Fabric (i.e. vinyl) – wiped using procedure above.
o Non coated cloth – launder.
o Non-washable fabrics not recommended
4.8
Electronic items
 Wipe equipment thoroughly including all cables, avoiding any electrical or electronic
connectors to prevent malfunction.
 Use approved screen cleaners
 Allow to air dry.
4.9
Toys
REFER TO IX0700 TOY M ANAGEMENT
4.10
Macerators (Vernacare)
 Dispose of cardboard items immediately after use into macerator and run cycle.
 Do not allow items to accumulate in macerator to avoid plugging the machine.
4.11
Washer/Disinfector (Deko)
 Place “blue ware” items used for elimination (i.e. bedpans, urinals) immediately in
machine after use.
 Once items are cleaned and disinfected, ensure clean items are stored to facilitate
complete drying.
 Items can be used for any patient after completing this process.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 3

5.0
Establish a schedule for regular cleaning of “blue ware” (i.e. wash basins, denture
cups).
4.12
Appendix B – Equipment Cleaning Table
4.13
Appendix C – information on hydrotherapy tubs and use of public pools for therapeutic
interventions.
REFERENCES
5.1
Best Practices for Cleaning, Disinfection and Sterilization in all Health Care Settings.
Provincial Infectious Diseases Advisory Committee (PIDAC), Ontario; February, 2010.
5.2
Hand Washing, Cleaning, Disinfection and Sterilization in Health Care. Health Canada Canada Communicable Disease Report. 1998; 24 Supplement 8: i-xi, 1-55.
5.3
Infection Control Guideline for the Prevention of Healthcare Associated Pneumonia.
Public Health Agency of Canada; 2010.
5.4
Infection Prevention and Control Manual. Capital Health. Cleaning and disinfection of
non-critical patient care equipment. Policy IC 08-001; July 2012.
5.5
Montana State Hospital. Policy and Procedure Manual. Cleaning of non-critical, reusable
patient care equipment. Policy IC-19; March 2010.
5.6
Saskatoon Health Region. Infection Prevention and Control Manual. Non-critical Patient
Care Equipment – Cleaning and Disinfection. Policy 20-80; October 2006.
5.7
Seven Oaks General Hospital. Policy and Procedure Manual. Cleaning of non-critical,
reusable patient care equipment. Policy Code: 7311-07-01; December 2007.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 4
APPENDIX A
Antiseptic
An antimicrobial chemical designed for use on the skin or mucous membranes that inhibits the growth
and reproduction of microorganisms (i.e.) alcohol based hand rub (ABHR) for hand hygiene.
Bioburden
The number and types of viable microorganisms that contaminate the equipment/device.
Cleaning
The physical removal of dirt, dust or foreign material. Cleaning usually involves soap and water,
detergents or enzymatic cleaners. Thorough cleaning is required before disinfection or sterilization
may take place.
Disinfectant
A product that is used on medical equipment/devices, which results in disinfection of the
equipment/device. Disinfectants are applied only to inanimate objects. Some products combine a
cleaner with a disinfectant.
High Level Disinfection
The process of using a chemical to kill all vegetative “live” bacteria, fungi, mycobacterium, and
viruses. This does not necessarily kill bacterial spores.
Intermediate Level Disinfection:
Inactivates M. tuberculosis, vegetative bacteria, most viruses, and most fungi, but does not
necessarily kill bacterial spores.
Low Level Disinfection
Using a chemical to kill most vegetative “live” bacteria and some fungi as well as enveloped viruses.
This does not kill mycobacterium or bacterial spores.
Noncritical Medical Equipment/Device
Equipment/device that either touches only intact skin (but not mucous membranes) or does not
directly touch the patient. Reprocessing of noncritical equipment/devices involves cleaning and may
also require low-level disinfection.
Personal Protective Equipment
Barriers placed between the infectious source and ones own mucous membranes, airways, skin, and
clothing to prevent exposure to blood and body fluids.
Reprocessing
The steps performed to prepare used medical equipment/devices for re-use (e.g., cleaning,
disinfection, and sterilization).
Sterilization
The complete elimination or destruction of all forms of microbial life. Accomplished by either physical
or chemical processes.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 5
APPENDIX B
Recommended Minimum Cleaning and Disinfection Level and Frequency for Noncritical Client/Patient/Resident Care Equipment and Environmental Items
The following chart relates to non-critical patient care equipment only, i.e.,
equipment that comes into contact with intact skin.
This chart also includes environmental surfaces and items that do not come
into contact with skin.
CL = Physical removal of visible soil dust or foreign material (may use soap and
water, detergent or hospital grade disinfectant with detergent properties)
LLD = Soak item in or wipe surfaces with hospital grade disinfectant (wipe or
cloth dampened with disinfectant), allow disinfectant to dry prior to reuse to
allow item “contact time” for disinfection to occur
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Minimum Frequency
Remarks
Airflow sensors
LLD

between patients

LLD

between patients
when soiled
(Sleep Lab)
Apnoea Monitor

Monitor/ Sensor Pad
Arrest Cart
See Resuscitation Cart
Basin
CL

after each use
 between patients



between patients
LLD
Note: in this document the term “patient” is inclusive of patient, resident or client.
clean with detergent and
water before disinfection
dedicated to patient
 dry completely before use
automated process
recommended
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 6
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Minimum Frequency
Bassinette
LLD

Remarks
weekly
when soiled
 between newborns

Bath Seat/ Raised Toilet
Seat
Single patient use
LLD
▪ when soiled
Multiple patient use
LLD
▪ between patients
Bedrail and extender
LLD
▪ daily
Mattress
LLD
▪ clean between
patients and when
soiled
Halo bed
LLD
▪ after each patient and
when soiled
Visitor cot
LLD
▪ change linen and
clean between uses
▪ ideally dedicated to each
patient
Bed
Bedpan and Urinal
▪ dispose immediately
Disposable
Multiple patient use
LLD
▪ between patients
▪ washer/disinfector
recommended for
reusable items after each
use
▪ remove gross soil and
fluids before automated
disinfection unless
machine equipped with
“flush” cycle
Bladder Scanner
LLD
▪ between patients
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 7
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Blood Pressure Cuff
LLD
Minimum Frequency

Remarks
between patients
 when soiled

ideally stays with patient
until discharge


dedicated to patient

discard when damaged or
heavily soiled

dry completely before
reuse

store with patient/baby to
avoid contact with other
kits
Breast Pump (Hospital
Grade)
Pump Kits
Disposable:CL
HLD(min)
Pump Motor
between uses
 when soiled

between uses
between different
patients
LLD

Call Bell
LLD
▪ daily and between
patients
Cardiac Monitor
LLD
▪ daily and between
patients
CL or
▪ when soiled
dedicated to patient –
washed and completely
dried after each use
 stored with patient/baby
 HLD/sterilized according
to Manufacturer’s
instructions before use
with another patient

between uses
 when soiled
Cast cutting
Blades
disposable
Saws
CL
▪ when soiled
Note: in this document the term “patient” is inclusive of patient, resident or client.
▪ send for sterilization if
contact with blood or body
fluids
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 8
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Minimum Frequency
Chair
LLD
▪ daily and when soiled
LLD

Remarks
Includes recliners, patient
chairs and shower
chairs
Chart Cover
when soiled

charts and clipboards
should not go into rooms
on Additional Precautions

replace worn binders
Binder and/ or clipboard
Clippers (handle)
Surgical
LLD
▪ between patients
▪ disposable heads
LLD
▪ when soiled
▪ ideally dedicated to each
patient
Commode Chairs
Single patient use
▪ patients with VRE or
C.difficile must have
dedicated commode
▪ for C.difficile, consider
cleaning with a sporicidal
agent
▪ remove gross soil and
fluids before cleaning and
disinfection
Multiple patient use
LLD
▪ when soiled
▪ between patients
Cord Clamp
Cyclers

LLD
▪ between patients
(Peritoneal Dialysis)
Defibrillator
▪ remove gross soil and
fluids before cleaning and
disinfection
See Resuscitation Cart
Note: in this document the term “patient” is inclusive of patient, resident or client.
must be single-use,
disposable and discarded
after use
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 9
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Minimum Frequency
Diagnostic Imaging
LLD
▪ when soiled and on
leaving Contact
Precautions room
LLD
▪ between patients if not
covered
LLD
▪ between patients
Portable - Machine
Portable - portable grid/
film cassette
Mammography - paddles
Dopplers
Transducers
LLD
Probes
LLD
Machine and Cables
Electric Razor
Razor body and Handle
LLD
ECG

after each use

after each use

between patients
Remarks
▪ ideally should be covered
(e.g., pillowcase)

wipe immediately after
use to remove residual
ultrasound gel before
cleaning

probes that contact
mucous membranes or
non-intact skin require
high-level disinfection
LLD
▪ as required
▪ must be single patient use
LLD
▪ when soiled
▪ ideally dedicated to each
patient
Electronic Devices
Single patient use
(e.g. Bedside monitors)
▪ between patients
▪ patients with VRE or
C.difficile should have
device cleaned daily
regardless of soilage
▪ for C.difficile, consider
cleaning with a sporicidal
agent
▪ remove gross soil and
fluids before cleaning and
disinfection
▪ consult manufacturers
instructions for screen
cleaning
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 10
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Minimum Frequency
Remarks
▪ cleanable covers are
highly recommended for
difficult to clean
components
Multiple patient use/
LLD
▪ when soiled
▪ between patients
Personal Devices used in
patient areas (i.e.
Tablets)
▪ remove gross soil and
fluids before cleaning and
disinfection
▪ consult manufacturers
instructions for screen
cleaning
▪ cleanable covers are
highly recommended for
difficult to clean
components
Glucometer
LLD
Halo Bed
See Bed
▪ after each use
Hydraulic Lift
LLD
Launder
▪ as required
▪ between patients and
when soiled
Interior
LLD
▪ every week
Exterior
LLD
▪ every week
Machine
Sling
Hydrocollator
Note: in this document the term “patient” is inclusive of patient, resident or client.
▪ dedicated to patient if
possible
▪ launder if visibly soiled
▪ drain and thoroughly clean
▪ allow 10 mins contact time
with disinfectant for
interior surfaces then
rinse well prior to refilling
with water
▪ allow fresh water to reach
appropriate temp prior to
re-immersing packs
▪ regular temperature
monitoring required as per
manufacturers
recommendations
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 11
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Minimum Frequency
Remarks
Interior
LLD
▪ every 6 months
▪ drain and thoroughly clean
with a de-limer
Exterior
LLD
▪ every 3 days
Ice Machine
Ice Packs
LLD
Intravenous (IV)
LLD

between patients

between patients
when soiled

Pumps, Poles, Warmers
Isolette
LLD
▪ do not use without a cover
▪ discard if damaged

weekly
 when soiled
Laryngoscope
Handle
Mattress
LLD

between patients
See Bed
Measuring Container
(urine)
CL
▪ after each use
LLD
▪ after each use
Ophthalmoscope
LLD

Orthopedic Equipment
LLD
▪ between patients
LLD

Single patient use
Multiple patient use
between patients
Crutches, traction etc.
Otoscope
Handle
between patients
Note: in this document the term “patient” is inclusive of patient, resident or client.
▪ one container per patient,
labelled with name
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 12
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Ear speculum
Disposable or HLD
Otoacoustic Emission
(OAE) screening tips
Disposable or HLD
Oxygen Delivery
Systems
Masks
NP/tubing
Disposable:CL
Disposable:CL
Minimum Frequency

between patients

between patients

daily
 when soiled

daily
 when soiled
Remarks

dedicated to patient

discard when damaged or
heavily soiled

rinse all disinfectants from
surface before reuse with
same patient

dry completely before
reuse with same patient

dedicated to patient

discard when damaged or
heavily soiled
(externally only)

Nebulizers

after use
Disposable:CL
Oximeter Probes
LLD
▪ between patients
Physio/OT Equipment
LLD
▪ between patients and
when soiled
Note: in this document the term “patient” is inclusive of patient, resident or client.
handle condensate
carefully – remove from
tubing, do not drain back
towards patient
 dedicated to patient

discard when damaged or
heavily soiled

rinse after cleaning using
sterile water

dry completely before
reuse with same patient

if single-use, discard after
use
▪ refer to manufacturer’s
instructions for cleaning
▪ discard if damaged
▪ educate users to clean
after use if appropriate
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 13
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Splint Baths
Sheepskin
Minimum Frequency
LLD
▪ weekly
Launder
▪
Remarks
▪ clean personal splints prior
to immersion
▪ drain and thoroughly clean
▪ allow 10 mins contact time
with disinfectant for
interior surfaces then
rinse well prior to refilling
with water
▪ allow fresh water to reach
appropriate temperature
before reuse
between patients
▪ when soiled
OT assessment Areas
CL
▪
(e.g. kitchen/bathroom)
after use
Wax Bath (wax)
Pillow
LLD
Reflex Hammer
LLD
Restraints
CL
Resuscitation
Cart/Arrest Cart
LLD
Defibrillator
LLD
▪ between patients and
when soiled
 between patients

between patients and
when soiled

weekly and after use

after each use
Note: in this document the term “patient” is inclusive of patient, resident or client.
▪ pour wax into disposable
plastic bag or washable
container for individual
patient use
▪ do not reuse wax
▪ discard if cracked

launder

avoid taking cart into
Contact Precautions
room, have a designated
clean person to pass
supplies as required
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 14
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Trays
LLD
Adult
LLD
Diaper
LLD
Newborn
LLD
Scales
Speculum Light
LLD
Stretcher
LLD
Stethoscope
LLD
Suction Machines
LLD
Table
Minimum Frequency

after each use

daily and when soiled

after each use

after each use

after each use

after each use

after each use

between patients
 when soiled

Bedside
LLD
Over bed
Telephone
when soiled
 between patients
 daily

Bedside/Nursing Station
LLD
daily
when soiled
 between patients


Portable
LLD
Telemetry Equipment
Monitor and Cables
LLD
daily
 when soiled
 between patients

between patients
Note: in this document the term “patient” is inclusive of patient, resident or client.
Remarks

all items taken into
Contact Precautions room
must be discarded and
not returned to the cart,
even if unopened

do not use phenolics

ideally use own
stethoscope

if shared, disinfect ear
pieces
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 15
Item
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
Minimum Frequency

when soiled
Thermometer
(electronic)
LLD
Tourniquet
LLD
Transfer Belts
CL

Transfer Boards
LLD

between patients

when soiled
LLD

after each use
LLD

after each use
Ultrasound Transducers
Handle and Cable
External
LLD

between patients
Urinal
See Bedpan
Urine Measuring
Container
See Measuring Container
Vacutainer Holder
LLD

between patients
Transport Equipment
Walker
Wheelchair
Tub
Bath board/Jets/Surfaces

when soiled
 daily
 between patients or
disposable
once weekly
 when soiled

preferably dedicate to
patient
 discard when soiled/
cracked

use transfer belts on top
of clean patient
clothing/gown

Ventilator
Machine
Remarks
CL

daily
 when soiled
 between patients
Note: in this document the term “patient” is inclusive of patient, resident or client.
Iodine and chlorine
products may damage tub
surfaces
 use high-level disinfection
for transducer probes if
they touch mucous
membranes or non-intact
skin

Single patient use
preferred

discard if visibly soiled
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 16
Item
Ventilator Circuit
Minimum Cleaning
and Disinfection
Level:
CL = Clean only
HLD = Clean + Highlevel Disinfection
LLD = Clean + Lowlevel Disinfection
LLD
Minimum Frequency
Remarks

between patients


disposable or
sterilized between
patients
ventilation circuits used on
an individual patient
should not be routinely
changed based on
duration of use – only
when visibly soiled or
mechanically defective

disposable or
sterilized between
patients


between patients
when soiled
CL

weekly
CL
CL


clean in dishwasher
if disposable, change daily
In-line monitoring devices
(i.e.temp. probes)
Walker
See Transport Equipment
Wall-mounted Oxygen
and Suction Fixtures
LLD
Warming Cupboard
Exterior
Interior
Water Jug
every 6 months
 daily

Wheelchair
See Transport Equipment
This document /excerpt was adapted with permission from the Ontario Agency for Health Protection
and Promotion (Public Health Ontario)/Provincial Infectious Diseases Advisory Committee (PIDAC).
PIDAC documents contain information that requires knowledgeable interpretation and is intended
primarily for use by health care workers and facilities/organizations providing health care including
pharmacies, hospitals, long-term care facilities, community-based health care service providers and
pre-hospital emergency services in non-pandemic settings. Public Health Ontario assumes no
responsibility for the content of any publication resulting from changes /adaptation of PIDAC
documents by third parties.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 17
APPENDIX C
Part 1: Infection Control Recommendations for Hydrotherapy
Recommendations for Hydrotherapy are required to prevent infections to pool participants and staff, as
well as to prevent contamination of the pool.
1. Contraindications: According to the BC Swimming Pool, Spray Pool and Wading Pools
Regulations, it is contraindicated for residents, staff, community clients or their attendants to
enter the pool with the following:
 Open areas of the skin (unless covered by a waterproof bandage).
 Fungal infections (i.e. Athlete’s foot, fungal infections of the groin).
 Unmanaged fecal incontinence.
 Fever, diarrhea or vomiting.
 Any other identified infections may be a contraindication. Appropriateness of swim
session for these cases will be at the discretion of the nurse, physiotherapist, doctor,
health care assistant, in consultation with the lifeguard.
2. Hand Hygiene: Hand hygiene is the single most effective measure available to prevent
infections. Hand hygiene should be done:
 Before and after direct care with a client.
 Before and after working with gloved hands.
 Before and after working with open areas/dressings, urinary equipment, ostomy
equipment or body fluids.
 Between working with different clients.
3. Urinary Incontinence:
 The bladder must be emptied before entering the pool.
4. Fecal Incontinence:
 Swimmers with fecal incontinence are requested to arrange their pool time around
their bowel habits.
 Swimmers are requested to have a bowel movement prior to bathing.
 Swimmers should wear properly fitting waterproof pants/incontinence product.
5. Ostomy Appliances:
 Must be firmly secured and able to withstand pool related activities (temperature,
moisture, body movements and exercises).
 It is the responsibility of the client, or the client’s attendant, to ensure that the bag is
secured to the body and free from seepage.
 Ostomy bags must be clean before entering the pool.
6. Skin lesions and Rashes:
 It is the responsibility of the client, or nurse, to check the skin for any wounds before
the pool session.
 If open wounds are present prior to swimming, the session should be cancelled.
 If the wound is small and can be completely covered and sealed by one waterproof
dressing, then the session can continue once the bandage had been properly
applied.
 Waterproof dressings can include various brands of waterproof bandages. Water
resistant bandages will allow water to move through the bandage therefore allowing
organisms to be carried to and away from the wound.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 18

Non waterproof bandages, tape, dressings, etc… must be removed before entering
the pool. Rationale: These items, if dislodged, become trapped in the pool filter
system resulting in mechanical breakdown. Also, if an open area is covered by an
inadequate dressing, the pool will potentially be contaminated.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 19
Part 2: Infection Control Practices for Pool Usage
Pool users are required to adhere to the following practices when using the pool:
1. All pool users are required to wash their hands upon arrival and before leaving the pool facility.
An antiseptic hand sanitizer solution is an option, if the hands are not visibly soiled.
2. All pool users are required to place a clean towel or other adequate barrier on the change bench
to sit on as well as place their clothing on while changing.
3. All clothing and personal belongings are to be stored neatly away in either the lockers or
underneath the benches after changing and while using the pool.
4. All pool users are required to take a cleansing shower using warm water and soap before
entering the pool.
5. No person shall enter the pool whom:
 Is obviously ill.
 Has an open wound that has not been appropriately covered.
 Has sore or infected eyes.
 Has a discharge from the ears or nose.
6. Disinfecting wipes should be supplied in each change room and should be used to wipe benches
between each use. Clients and staff are encouraged to use these wipes before and after using
the benches. The wiped surface is left to air dry for effective disinfecting.
7. Disinfecting wipes are also used to wipe the grab bars and lifts after each use.
8. Disinfecting wipes are used to wipe the sling back and lift after each use. Lift slings should be
washed after each use.
9. Change rooms should be cleaned and sanitized thoroughly once daily, or more often, as needed.
10. The pool deck should be cleaned and sanitized thoroughly once daily, or more often, as needed.
11. Wheelchairs that have been contaminated with body fluids are cleaned in the following manner:
excess contaminant is absorbed with paper towel. The chair is then rinsed under a shower with a
continuous flow of clean water. Disinfectant is then sprayed on the item and left for a minimum of
10 minutes (or per manufacturer instructions). The chair is then rinsed under clean water again,
before storing it its regular location.
12. Head floats that have been contaminated with feces or blood will be thrown out. Other body
fluids contaminating the head floats can be either wiped with a hospital approved disinfectant or
washed in the washer.
13. Body fluid spills, (outside the pool basin) are first soaked up using paper towel. Dispose of the
paper towel in the garbage. A hospital approved disinfectant is then used to wipe the area, which
is left to air dry. A mop can be used for large spills after the paper towels have absorbed as
much of the spill as possible. Mop head must be washed and disinfected before reuse on
another surface.
14. Vomit in the pool may create a higher risk for infection.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 20
Part 3: Infection Control Guidelines for Staff
1. Staff are expected to follow the same infection control guidelines set out for community clients.
These include washing hands upon arriving at work, protecting open wound with waterproof
dressings, putting a towel down on any bench you use to change on, ensuring your belongings are
tucked away while working and having a cleansing shower before and after using the pool.
2. Staff are also expected to ensure a clean environment by doing the following:
 Remind community clients to wash their hands upon arrival.
 Remind community clients to take a cleansing shower before entering the pool.
 Remind community clients to place their towel down upon the bench to sit on while changing.
 Wipe the benches in the change room with a hospital approved disinfectant as often as time
permits, preferably between each client.
3. Staff are expected to wear appropriate footwear around the pool following the footwear guidelines for
pool staff.
4. Staff should encourage clients to wear appropriate footwear around the pool facility.
5. Do not allow any open wounds that are not appropriately covered in the pool.
Part 4: Responding to Fecal Accidents in Rehabilitation Swimming Pools
Information from the Center for Disease Control (Atlanta, Georgia) addresses fecal accidents in pools. In
recent times, there have been increasing concerns about the transmission of Cryptosporidium parvum in
swimming pools. While this parasite can cause self-limited diarrhea in healthy people, the diarrhea can be
much more significant in those with severe immunosuppresion. The infecting dose of Cryptosporidia is quite
small, and even a small visible fecal spill of liquid can contaminate an entire pool. Most bacteria are very
susceptible to low concentration of free chlorine, however, Cryptosporidia are not. Chlorine (2ppm) kills
Escherichia coli in less than 1 minute, while Cryptosporidia may require as long as 8 hours.
Although Cryptosporidia may be found in the stool of people who have persistent diarrhea and nausea,
investigators from the CDC have demonstrated Cryptosporidia are not carried as normal human enteric flora,
and is not found in formed stool.
In order to address the potential hazards of Cryptosporidia parvum, pool protocols have been designed to
combat this organism. This has lead to the recommendation of raising chlorine concentrations for up to 8
hours, and to maintain the pool unused for 3-4 filtration cycles for 24 hours.
The consequences of these policies have been significant on pools used for rehabilitation patients. Many
individuals may have incompetent sphincter control, resulting in minor incontinence without diarrhea or being
unwell. Small accidents, which have been totally contained within the bathing suit, are a relatively common
occurrence. Unfortunately, these occurrences have been sufficient to trigger pool-closure responses, which
last 24 hours. The consequence is that pools may be closed as often as they are open. This results in
severe restrictions, inconvenience, and loss of valuable therapeutic pool time for many individuals.
To address pools potential contaminated with feces or vomit, please refer to the “Fouled Pool Remedial
Procedure”.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - 1X0600 (Equipment Cleaning)
Page 21
REFERENCES
BC Health Act, “SWIMMING POOL, SPRAY POOL AND WADING POOL REGULATIONS”, B.C. Reg.
289/72,O.C. 4190/72 Responding to fecal accidents in disinfected swimming venues. CDC MMWR weekly.
May 25, 2001. 50(20); 416-417.
Vancouver Coastal Health. Guidelines for the Stan Stronge Pool.
Provincial Infection Control Network of British Columbia. Appendix 7: Pools. PICNet Antibiotic Resistant
Organism Provincial Guidelines. Draft Two. April 18, 2008.
Interior Health Fouled Pool Remedial Procedures
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0700 (Toy Management)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX0700:
Toy Management
EFFECTIVE DATE: September 2006
REVISED DATE: November 2010
REVIEWED DATE:
1.0
PURPOSE:
To prevent transmission of infections by contact routes, toys used in any department, inpatient unit or
practice for therapeutic, diagnostic or entertainment purposes will be cleaned/disinfected on a routine
basis and when visibly soiled .Recognizing the importance of play and education to a hospitalized
child and realizing the potential of spread of infection with shared toys, hands and person-to-person
contact, the following guidelines are recommended.
2.0
GENERAL PRINCIPLES
2.1.
Only toys that can be easily cleaned (plastic or non-porous) are provided.
2.2.
Stuffed toys are not permitted. If a child must have a stuffed toy, it must be labeled with the
child’s name, used only by that child and sent home or discarded at discharge.
2.3.
Mobiles that contain stuffed toys are not allowed.
2.4.
No special precautions are needed for magazines or books, unless visibly soiled. Items that
cannot be cleaned with hospital-approved disinfectant or soap and water should be
discarded.
Rooms with children on Additional Precautions will remain there throughout hospitalization.
When the patient is discharged, toys should be disinfected with hospital-approved
disinfectant before return to a central storage area.
2.5.
3.0
2.6.
Stuffed toys in common areas such as halls, waiting rooms, family rooms that are used to
enhance the décor are not permitted.
2.7.
Communal toys including large wheel toys are cleaned weekly and when visibly soiled.
2.8.
Toys used for testing will be cleaned after each use.
PROCEDURE
3.1. Use regular soap and water for cleaning visible dirt/soil.
 Wash toys with soap using friction.
 Rinse with water and dry.
3.2.
Hospital approved disinfectant for cleaning toys that are mouthed or contaminated and those
used with children on Additional Precautions.
 Wipe toys with disinfectant.
 Allow 10 minutes contact time.
 Rinse with water and dry.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X - IX0700 (Toy Management)
Page 2
4.0
REFERENCES:
4.1.
Guidelines for Isolation Precautions in Hospitals, Hospital Infections Program, Center for
Infectious Diseases, Center for Disease Control, U.S. Department of Health and Human
Services, Atlanta, Georgia, 1996.
4.2.
APIC Text 2009; Chapter 39 Pediatrics, Basic Principles
.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX0800 (Personal Care Supplies Best Practice Guidelines)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is located on
IHNET at the Policies & Procedures Home Page
IX0800: Personal Care Supplies
Best Practice Guidelines
EFFECTIVE DATE: June 2009
REVISED DATE: November 2010
REVIEWED DATE: February 2015
1.0
PURPOSE:
To ensure that personal care supplies are not shared and are kept clean and prevent transmission of
microorganisms to other patients and healthcare providers.
2.0
DEFINITION
Personal care supplies include items used for bathing, skin care, nail care, oral hygiene, denture
care, dressing care and incontinence care.
Included are the following items:
 Skin cleansers.
 Lotions.
 Creams.
 Soaps.
 Razors.
 Toothbrush.
 Toothpaste.
 Denture box.
 Comb and hairbrush.
 Nail file and clippers.
 Dressing supplies.
 Any other articles needed for personal hygiene.
3.0
GENERAL PRINCIPLES:
Personal care supplies should not be shared between patients.
3.1
Acute Care, Rehabilitation units, and Psychiatry units
 Each patient should bring in his/her own personal care items.
 Electric razors should not be shared between patients.
 Personal disposable razors can be used and must be disposed of in designated waste
receptacle.
 Nail/foot care equipment must be sterilized between patients.
 Lotions, soaps and creams - Use a ‘tongue’ depressor or separate cup to dispense to
avoid contamination of the bottle and contents.
 Unused products kept at the bedside should not be restocked unless they can first be
appropriately cleaned and disinfected. Single-use items must not be reprocessed and
must be discarded.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX0800 (Personal Care Best Practice Guidelines)
Page 2
4.0
3.2
Residential Care
 Each resident must have his/her own personal care items.
 Personal care items should be cleaned regularly.
3.3
Foot care clinics or contractors coming into Interior Health facilities
 Shared foot care equipment must be sterilized between residents/clients. This includes
clippers, files, and scissors.
PROCEDURE
4.1
Labeling
 Each patient’s personal supplies should be identified with his/her name and kept at
his/her bedside in a clean container (e.g. in a washable cosmetic bag or plastic
container). Toothbrush and oral hygiene products should be kept in a separate bag or
container at the bedside.
 Patient’s personal care items must be sent with the patient when discharged.
4.2
Cleaning and Storage
Lotions:
 Preferably, use lotions in a bottle with a pump and labeled with patients name.
Soaps:
 Bar soap must be kept in a clean, dry soap dish that allows the bar to drain between
uses.
 Personal liquid body soap is preferred because it is more easily stored between uses.
Wound/Skin Cleansers:
 Wound and skin cleansers must not be shared. Each patient should have a personal
cleanser labeled with the patient name.
 Each resident should have a personal incontinence care cleanser labeled with their
name.
Creams:
 Use a tongue depressor to dispense cream from jar to avoid contaminating the cream.
Toothbrush:
 Change every three months and after an illness. Keep in a plastic toothbrush container.
Ensure it is stored protected from toilet aerosols.
Denture box:
 Label with patient name. Rinse and dry daily.
Comb and Hairbrush:
 Label with patient name. Clean at the same time as hair is washed. Clean in hot soapy
water, rinse and allow to air dry.
Hair Rollers:
 Wash in hot soapy water between residents.
Nail file and clipper:
 Label with patient name. Clean and dry after each use.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX0800 (Personal Care Best Practice Guidelines)
Page 3
Razors:
 Clean electric razors after each use with a personal razor brush. Don’t share.
 Personal disposable razors can be used and must be disposed of in designated waste
receptacles.
Bedpans:
 Clean and disinfect after each use. Never place on the floor.
 Disposable bedpans are acceptable.
Bowls for washing:
 Clean with soap and water and dry after each use.
5.0
REFERENCE:
5.1
Infection Prevention and Control Best Practices For Long Term Care and Community Care
Including Health Care Offices and Ambulatory Clinics. June 2007 Sponsored by Canadian
Committee on Antibiotic Resistance.
5.2
Routine Practices and Additional Precautions for Preventing the Transmission of Infection in
Health Care Settings; Public Health Agency of Canada; 2013.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX0900 (Construction Projects)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX0900:
Construction Projects
EFFECTIVE DATE: September 2006
REVISED DATE: September 2012
December 2012, December 2014
REVIEWED DATE:
1.0
PURPOSE
Construction projects, in particular renovation projects, pose potential health risks for patients,
staff, visitors and construction personnel that may lead to healthcare associated infections.
These risks most commonly develop when dust particles contaminated with bacteria and/or fungi
are dispersed into adjacent patient care areas. The primary fungus associated with these
infections is Aspergillus while the main bacterium is Legionella.
Note





.
CSA Z317.13-12 Dec 2012 shall be used to determine population risk group,
construction activity type, and preventative measures.
Prevention Measures will be outlined in the construction documentation prior to
the construction project starting and prior to the project going to tender.
Class of Preventative Measure Level I and II will be determined by the Plant
Services staff in the facilities. If Plant Services staff has questions pertaining to
the stratification of the risk groups, the Infection Prevention and Control
Practitioner will be contacted.
Infection Prevention and Control Practitioners will be involved in all discussions
involving the Class of Preventative Measure Level III and IV and the ICP will sign
off the Infection Control Construction permit.
The Infection Control Practitioner must be given a minimum of 48 hours
notice by anyone requesting a permit before the scope of work can be
assessed and a permit issued.
The IX1000 Construction and Renovation Guidelines are the specifications that are provided
to the consultants in the tender package. This document will be included in the Request for
Proposal as well as the “front end” document that Facilities Management provides to the
consultants when preparing tenders.
All new projects or renovations shall ensure that appropriate infrastructure is in place to support
the IH hand hygiene program and will follow the CSA Z8000-11 standards.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX0900 (Construction Projects)
Page 2
2.0
References
2.1
CSA Standard: Canadian health care facilities. CSA Z8000-11 September 2011.
2.2
CSA Standard: Infection Control during Construction or Renovation of Health
Care Facilities. CSA Z317.13 – 12 Dec 2012
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 1
A PRINTED copy of this guideline may not be the most recent version. The OFFICIAL version is
located on IHNET at the Policies & Procedures Home Page
IX1000:
Construction & Renovation Guidelines
EFFECTIVE DATE: September 2006
REVISED DATE: September 2012
December 2012, February 2013, March 2013
May 2014
1.0
REVIEWED DATE:
PURPOSE
To prevent construction or renovation related infections in staff, clients and visitors.
To provide guidelines to be followed during construction or renovation of health care facilities.
2.0
GUIDELINE
2.1.
Pre-Approval Assessment
A well-managed multidisciplinary team with appropriate expertise will be established early
in the planning stage of construction and renovation projects. The multidisciplinary team
shall include:

Infection prevention and control.

Administration.

Project management.

Environmental services.

Health care (e.g. medical and nursing staff).

Design (e.g. architects, engineers).

Operations and maintenance.

Construction/renovation personnel.
Assessment of the risks to occupants of the health care facility is necessary before
construction or renovations begin. The Planning Department and Engineering or
operations and maintenance will keep the Infection Control Service informed regarding
the location of all areas of renovation and construction as soon as possible, during the
planning stages.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 2
2.2.
Approval
The Infection Control /Construction Form will be used by the Infection Control
Practitioner, or designated person, when assessing projects. All construction and
renovation shall utilize CSA Z317.13-12 to determine risk group, construction activity
type, and preventative measures( Appendix 1-3).
The Infection Control Service must review all planned projects falling under the category
of Class of Preventative Measure Level III and IV. All construction workers must follow
the infection control procedures described in this guideline.
Engineering or operations and maintenance and/or the Planning Department in
collaboration with the Infection Control Service will determine the Class of Construction
Activity for each project.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 3
Infection Prevention and Control Measures for New Projects
For preventative measures III and IV (includes new construction projects, construction on
vacant land, facility additions, and space redevelopment) the following shall apply:

Prior to construction the constructor shall present an infection control plan to the
multidisciplinary team including selection, design, application, specification, and
assembly of construction materials to be used in the project.

Constructor proposed infection prevention and control measures must encompass
the duration of the project and ongoing maintenance and operations.

The multidisciplinary team shall communicate its policies and procedures to the
constructor before construction begins.

The constructor should designate an individual responsible for infection control to
liaise with the multidisciplinary team and monitor and coordinate the infection
control procedures. The multidisciplinary team should designate a representative to
communicate with the constructor and attend construction meetings as necessary.

On approval of the infection control plan by the multidisciplinary team, the
constructor should coordinate infection control education sessions for all suppliers
and subcontractors participating in the project. A copy of the infection control plan
shall be provided to all subcontractors and compliance will be imposed in all
subcontracts.

Infection Prevention and Control Practitioners will be involved in all discussions
involving the Class of Preventative Measure Level III and IV and the ICP will
sign off the Infection Control Construction permit.

The Infection Control Practitioner must be given a minimum of 48 hours notice
by anyone requesting a permit before the scope of work can be assessed and a
permit issued.

Infection prevention and control measures shall be constantly monitored and shall
be reviewed at every construction and project management meeting.

If, during construction, events that can present infection risks occur, intervention
procedures shall be implemented immediately to resolve the problems.

Plumbing and HVAC systems shall be supplied, installed, and commissioned in
accordance with CAN/CSA-Z317.1, CAN/CSA-Z317.2, and CAN/CSA Z318.0.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 4
2.3.
Project Monitoring
An ICP shall
ensure that the appropriate preventative measures are initiated and adhered to.
As a member of the multidisciplinary team, the ICP shall have the authority to stop
construction if there is a significant failure to adhere to the required preventative
measures. The multidisciplinary team shall have a procedure in place for notifying
relevant HCF and construction management personnel in the event of a construction
stop.
2.4.
Infrastructure
All projects, both new construction and renovation, shall utilize CSA Z8000-11 standards
to ensure that appropriate infrastructure is in place within IH healthcare
facilities(Appendix 4.)
3.0
REFERENCES
3.1.
Canada Communicable Disease Report: Construction-related nosocomial infections in
patients in health care facilities. July 2001
3.2.
CSA Standard: Infection Control during Construction or Renovation of Health Care
Facilities. CSA Z317.13 – 12 Dec 2012
3.3.
CSA Standard: Canadian health care facilities. CSA Z8000-11 September 2011.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 5
APPENDIX 1
Infection Control Construction Permit / Sign Off Form
Location of Construction:___________________
Supervisor:____________________
Project Coordinator: ____________________
Project Start Date: ___________________
Contractor Performing Work:___________________
Estimated Duration: __________________
Supervisor:___________________
Telephone:____________________
YES
NO
CONSTRUCTION LEVEL
YES
NO
TYPE A: Inspection, non-invasive activity
TYPE B: Small scale, short duration, moderate
to high levels
TYPE C: Activity generates moderate to high
levels of dust, requires greater 1 work shift for
completion
TYPE D: Major duration and construction
activities requiring consecutive work shifts
Area Free of Hazardous Materials:
Yes
No
Population RISK GROUP
GROUP 1: Least Risk
GROUP 2: Medium Risk
GROUP 3: Medium/High
Risk
GROUP 4: Highest Risk
(if No, attach description and abatement requirements).
Visual Checklist for work within existing building to check for Mold Presence completed.



Mold Presence not detected
Mold Detected
Abatement Complete
Type of Construction or Renovation: Circle
A
B
C
Population Risk Group: Circle
2
3
4
1
D
(Risk Assessment for Types of Construction
Activity Table, Schedule 1)
CLASS OF PREVENTATIVE MEASURE
Construction Level (Type A,B,C,D)
Type A
Type B
Type C
Type D
II
III/IV
II
III
IV
III
III/IV
IV
III/IV
IV
Group 1
I
Group 2
I
Group 3
I
Group 4
I - III Contact IC
III/IV
Class of Preventative Measure Required:
Level
Has the multidisciplinary team been involved; Yes
II
I
II
III
IV
No
Date: ___________________________
Date: ___________________________
________________________________
Interior Health – Infection Control Professional
________________________________
Construction Representative
Additional Requirements: Attach copy
Date: ___________________________
Signature: ___________________________
Date: ___________________________
Signature: ___________________________
Infection Control Measures in Place. Work Authorized to Proceed:
Date: ___________________________
Date: ___________________________
________________________________
Interior Health – Infection Control Professional
________________________________
Construction Representative
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 6
Original: Infection Control Practitioner
Copy: Project Manager or Plant Manager
APPENDIX 2
Schedule 1
Type of Construction Activity for Risk Assessment: (Table 3: taken from CSA Guideline Z317.13-12
Dec 2012)
Construction Level Type A:
Inspection, non-invasive activities
a)activities that require removal of not more than one ceiling tile
or require wall or ceiling panels to be opened;
b)painting (but not sanding) and wall covering;
c)electrical trim work;
d)minor plumbing work that disrupts the water supply to a
localized patient care area (i.e. one room) for less than 15 min.;
and
e)other maintenance activities that do not generate dust or
require cutting of walls or access to ceiling other than for visual
inspection.
Construction Level Type B:
a) activities that require access to chase spaces;
Small scale, short duration activities
that create minimal dust. These
include, but are not limited to,
b) where dust migration can be controlled, cutting of walls or
ceilings for installing or repairing minor electrical work,
ventilation components, telephone wires, or computer cables;
c) sanding or repair of a small area of a wall; and
d) plumbing work that disrupts the water supply of more than
one patient care area (i.e. two or more rooms) for less than
thirty min.
Construction Level Type C:
Activities that generate a moderate to
high level of dust, require demolition,
require removal of affixed facility
component (e.g. sink) or assembly
(e.g. countertop or cupboard), or
cannot be completed in a single work
shift. These include, but are not
limited to,
a) activities that require sanding of a wall in preparation for
painting or wall covering;
b) removal of floor coverings, ceiling tiles, and case work;
c) new wall construction;
d) minor duct work;
e)electrical work above ceilings;
f) major cabling activities; and
g) plumbing work that disrupts the water supply of more than
one patient care area (i.e. two or more rooms) for more than 30
min but less than 1 h.
Construction Level Type D:
Activities that generate high levels of
dust, and major demolition and
construction
activities
requiring
consecutive work shifts to complete.
These include, but are not limited to,
a) activities that involve heavy demolition or removal of a
complete cabling system;
b) new construction that requires consecutive work shifts to
complete;
and
c) plumbing work that disrupts the water supply of more than
one patient care area (i.e. two or more rooms) for 1 h or more.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 7
Border Risk Groups Assessment (Table 2: taken from CSA Guideline Z317.13-12 Dec 2012)
Group 1

Office areas
Lowest Risk

Unoccupied wards

Public areas

Laundry and Soiled Linen cleaning areas

Physical Plant Workshops and housekeeping areas
Group 2

Patient care areas unless listed in Group 3 or 4
Medium Risk

Outpatient clinics (except for oncology & surgery)

Admission and discharge units

Waiting rooms

Autopsy and morgue

Occupational therapy areas remote from patient care areas

Physical therapy areas remote from patient care areas
Group 3

Emergency (except trauma rooms)
Medium to High Risk

Diagnostic Imaging

Labor & birthing rooms (non-operating)

Nurseries for healthy newborns

Nuclear medicine

Hydrotherapy

Echocardiography

Laboratories

General Medical and surgical floors

Pediatrics

Geriatrics

Long Term care

Food preparation serving and dining areas

Respiratory therapy

Clean linen handling and storage areas

Intensive care units (ICU’s)

Operating rooms (including prep, induction, post-anesthetic care unit
Group 4
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 8
Highest Risk
(PACU), and scrub areas

Anesthesia storage areas and work rooms

Oncology units and outpatient clinics for cancer patients

Transplant units and outpatient clinics for transplant patients

Wards and outpatient clinics for patients with AID’s or other
immunodeficiency diseases

Dialysis units

critical care nurseries (NICU)

Labor and delivery operating rooms

Cardiac catheterization and angiography areas

Cardiovascular and cardiology patient areas

Endoscopy

Pharmacy admixture rooms

Sterile processing rooms

Sterile supply areas

Burn care units

Animal rooms

Trauma rooms

Protective environment isolation rooms

Tissue culture laboratories

Bronchoscopy

Cystoscopy

Pacemaker insertion rooms

Dental procedure rooms

Central processing department
Construction activity and Risk Group Matrix

The Infection Control Service must be involved with the multidisciplinary team at the planning stage
for all Class of Preventative Measure Level III and IV activities. An Infection Control Practitioner will
be assigned to each project and will regularly visit the construction area.

Please notify the Infection Control Service when work is being done on hallways adjacent to patient
care areas that fall into a Population Risk Group of 3 or 4.

Circumstances may necessitate changing the Class of Preventative Measure Level at any time during
the project. Any changes to the scope of work, the Infection Control Practitioner assigned to the
project, must review to determine if there is a further impact on infection control.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 9
CLASS OF PREVENTATIVE MEASURE
Construction
Level Type A
Populations
Construction
Level Type B
Construction
Level Type C
Construction
Level Type D
I
II
II
III/IV
I
II
III
IV
I
III
III/IV
IV
I – III
III/IV
III/IV
IV
Risk Group 1
Population
Risk Group 2
Population
Risk Group 3
Population
Risk Group 4



*Contact infection
control to ensure
appropriate
classification
See Table 3 for Construction Activity and Table 2 for Population Risk Group.
Shaded activity areas indicate increased risks to population and implementation of stringent Infection
Control precautions. Infection Control Construction Permit/Sign Off Form required for all Construction
Activity.
When the Class of Preventive Measure is Level III/IV, a multidisciplinary team shall determine the
appropriate prevention measures required, either Level III or Level IV.
Guidelines for Dust Containment during Construction
Engineering and operations or maintenance staff and/or the Planning Department in collaboration with the
Infection Control Service will determine the Class of Construction Activity for each project. Please refer to
the guidelines below for dust control measures for the Activity Class of the project. If the level of
construction activity changes during the course of the project, please notify Engineering and operations or
maintenance, and/or the Planning Department and/or the Infection Control Service before proceeding.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 10
APPPENDIX 3
CLASS OF
PREVENTATIVE MEASURE
Level I
Engineering or Operations and Maintenance Staff or Constructors




Minimize dust during construction operations.
Clean the work area with a HEPA vacuum cleaner if necessary.
Wipe work surfaces with a hospital approved disinfectant after the project is completed.
Immediately replace any ceiling tile or access panel displaced for visual inspection.
Plumbing Activities





Schedule water interruptions during low activity.
Flush water lines for a minimum of 10 minutes prior to reuse - check for discolored water.
Ensure that gaskets and items made of materials that support the growth of Legionella are not
being used.
Ensure faucet aerators are not installed or used.
Maintain as dry an environment as possible and report any leaks that occur to walls and
substructures.
Environmental Services

Report discolored water and water leaks to Maintenance and Infection Control.
Medical/Nursing Staff


Minimize patients' exposure to construction/renovation area.
Ensure that patient care equipment and supplies are protected from dust exposure.
After construction
 The multidisciplinary team shall review the preventive measures that were undertaken and
assess their effectiveness.
Level II
Note: In addition to following preventative measure I the following measures shall be met.
Engineering or Operations and Maintenance Staff or Constructors








Seal windows and unused doors.
Seal plumbing penetrations, electrical outlets, and any other sources of potential air leaks in the
construction area.
Seal air vents in the construction area and if possible disable until construction completed
Use drop sheets to control dust.
Place walk off mat outside of entrance of construction area to trap dust from the equipment and
shoes of personnel leaving the area.
Wet mop and /or vacuum (with HEPA filtered vacuum) at end of day as well as when the mat is
visibly soiled.
Walk off mats shall be of sufficient size to ensure that constructors have to place both feet on the
mat at least once on exiting the construction area.
Water mist work surfaces to control dust while cutting (note: caution should be exercised when
such techniques are used on cellulose or fibre based materials that are intended to stay in place
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 11
following construction work).




Contain debris in covered containers or cover with a moistened sheet before transporting it for
disposal.
Place supplies and equipment in covered containers during transportation through the healthcare
facility to prevent contamination in other areas.
Remove debris in the evening when patients are in their rooms and visitors have left. If this is not
possible debris should be removed at the end of the work day.
Wipe work surfaces with a hospital approved disinfectant at end of project
Plumbing Activities



Avoid collection tanks and long pipes that allow water to stagnate.
Hyper chlorinate (to a minimum of 50 parts per million) or superheat (to a minimum of 70 degrees
Celsius) stagnant domestic water (especially if Legionella is already present in the domestic water
supply). The water lines in the construction area and adjacent patient care areas shall be flushed
for a minimum of ten minutes before reuse; and note: Preventative technologies (e.g. silver-copper
ion treatments) may be considered in lieu of the techniques specified above.
Be aware of the impact of techniques to remove bacterial growth and choose the approach that
minimizes the risks associated with such work
Medical/Nursing Staff/Administration

Identify high-risk patients who may need to be temporarily moved away from the construction
zone.
After Construction
 The multidisciplinary team shall
a. Review the preventive measures that were undertaken and assess their effectiveness;
and
b. Conduct a final inspection to ensure that the ventilation system is functioning properly
in the construction area and adjacent areas.
 Infection prevention and control personnel shall ensure that the construction area has been
thoroughly cleaned before building occupants are readmitted to the completed construction
area.
 Environmental services and healthcare staff shall
a. Ensure that the construction area has been cleaned with a HEPA filter-equipped
vacuum cleaner, a wet mop, or both, as necessary, and that horizontal work surfaces
have been wiped with a disinfectant; and
b. Report discolored water and water leaks to the maintenance and infection prevention
and control departments.
Level III
Note: In addition to following preventative measures I and II the following measures shall be
met.
Minimization of dust generation and dispersal
Engineering or Operations and Maintenance Staff or Constructors

Erect an impermeable dust barrier, from the floor to the underside of the deck (including the
areas above false ceilings) consisting of two layers of 0.15mm (6 ml) fire-retardant polyethylene
(or an equivalent barrier) and gypsum wall board protection approved by the multidisciplinary
team. The dust barrier shall remain in place until the project is complete and the area has been
cleaned thoroughly and inspected. After construction has been completed, the dust barrier shall
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 12
be removed to prevent the spread of dust and other debris particles adhering to the barrier;

Use impermeable vessels constructed to contain contaminants. Such vessels shall have a
monolithic (one-piece) exterior shell constructed of a minimum of 0.20 mm (8 ml) fibrereinforced, fire-retardant polyethylene. The construction of the vessel shall allow for
containment of contaminants within the vessel and have ports through which HEPA-filtered
vacuum cleaners or portable construction HEPA-filtered air units can be easily attached to draw
the unit under negative pressure;

Vacuum mechanical and electrical systems and spaces above drop or false ceilings, if
necessary; and

Remove protective clothing before entering patient care areas.
Ventilation Systems
Engineering or Operations and Maintenance Staff or Constructors

Disable the ventilation system and seal duct openings in the construction area until the project
is completed;

Maintain a negative pressure of 7.5pa (0.03 in wc) within the construction area using portable
HEPA filter-equipped air filtration units that include pressure gauges and an alarm. Filters shall
be monitored and replace if clogged or functioning below the manufacturers specifications;

Ensure that the air is exhausted directly outside and away from intake vents and filtered
through an HEPA filter. In conditions that prohibit exhausting exhaust outside, air may be
recirculated in accordance with Clauses 6.6 and 7.2.3.6 (CSAZ317.13-12); and

Ensure that the ventilation system is functioning properly and cleaned if contaminated by soil or
dust after the construction project is complete.
Portable construction HEPA-filtered air units

Construction area exhaust shall be HEPA filtered. Filters shall be visually inspected by the
constructor at least daily, condition documented, and replaced when loaded.

HEPA filtered air units shall be certified at the beginning of any preventative level III or IV
construction activity. Units shall be recertified at least every 12 months and the recertification
shall be documented.

Construction, maintenance, and repair area exhaust air shall not be discharged to areas
occupied by Population risk group 3 or 4. Measures related to recirculated air shall require
approval from the multidisciplinary team.

The relative space pressures between areas occupied by Population risk group 3 or 4 shall be
continuously monitored.
Impact on the facility HVAC system

Portable air filtration units may affect a facility’s HVAC system; therefore,

The main facility system shall be verified for operation in accordance with design during
construction work.

The healthcare facility and constructor shall verify the pressure relationships for critical areas
near the construction area.
Construction air handling

Permanent air handling systems should not be used for exhausting air from construction or
renovation work areas. Temporary duct work may be installed for such purposes. However, it
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 13
shall not connect to the facility’s HVAC system.

In cases where air cannot be directly exhausted outside(not tying into another system), exhaust
air may be piped to the building exhaust system if an engineering analysis has been performed
by qualified personnel to ensure that the exhaust air will not be re entrained into the occupied
building and the multidisciplinary team approves piping to the exhaust system.

Where air cannot be directly exhausted outside or piped through the building exhaust system, it
may be recirculated into areas of the building occupied by Risk Group 1 or 2 if multidisciplinary
team approval is granted. Construction exhaust air shall not be recirculated into building areas
occupied by Risk Group 3 or 4.
Cleaning and Maintenance

Engineering or operations and maintenance staff in the construction area shall clean outside
the work area with a HEPA filter-equipped vacuum cleaner every day or more frequently if
necessary.

Environmental services staff shall
a. Increase the frequency of cleaning adjacent to the construction area.
b. Wet mop and vacuum the area with a HEPA filter-equipped vacuum cleaner as
necessary and when the work is complete; and
c.
Wipe exposed surfaces with a hospital grade disinfectant.
Role of infection prevention and control personnel

To collaborate with the environmental services staff to ensure the construction area is
thoroughly cleaned when work is complete;

Inspect the integrity of dust barriers; and

In collaboration with the facility program manager, designating a traffic pattern for constructors
that avoids patient care areas and a traffic pattern for clean or sterile supplies and equipment
that avoids the construction area.
Role of healthcare staff
Healthcare staff shall

Ensure that patient care equipment and supplies are protected from dust exposure;

Ensure that patients do not go near the construction area;

Ensure that staff do not visit the construction area; and

Report discolored water and water leaks to maintenance and infection prevention and control
personnel.
After Construction
 The multidisciplinary team shall
c. Review the preventive measures that were under taken and assess their effectiveness;
and
d. Conduct a final inspection to ensure that the ventilation system is functioning properly
in the construction area and adjacent areas.
 Infection prevention and control personnel shall ensure that the construction area has been
thoroughly cleaned before building occupants are readmitted to the completed construction
area.
 Environmental services and healthcare staff shall
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 14
c.
Ensure that the construction area has been cleaned with a HEPA filter-equipped
vacuum cleaner, a wet mop, or both, as necessary, and that horizontal work surfaces
have been wiped with a disinfectant; and
d. Report discolored water and water leaks to the maintenance and infection prevention
and control departments.
Level IV
Note: In addition to following preventative measures I, II, and III the following measures shall be
met.
Engineering or Operations and Maintenance Staff or Constructors

Ensure that all access shall be from outside the occupied areas of the healthcare facility, or
construct anterooms at access points to the construction area if access is from within the
healthcare facility;

Place a walk-off mat outside and inside the anteroom to trap dust from equipment, debris, and
the shoes of personnel leaving the construction area. Walk off mats shall be of sufficient size to
ensure that constructors have to place both feet on the mat at least once on exiting the
construction area;

Ensure that the constructors
a. Leave the construction area through the anteroom so that they can be vacuumed with
a HEPA filter-equipped vacuum cleaner before leaving; or
b. Wear protective clothing that is to be removed each time they leave the construction
area and before going into patient care areas;
c.
Repair holes in walls within 8 hours or seal them temporarily;
d. Ensure that ventilation systems are working properly in adjacent areas; and
e. Carefully remove barrier walls and use short term protection to minimize environmental
contamination during removal.

Environmental services staff shall ensure that the construction area is thoroughly cleaned when
work is complete.

Infection prevention and control personnel shall regularly visit the construction area to ensure
that preventative measures are followed. The frequency of their visits shall be determined by
the multidisciplinary team

Infection prevention and control measures shall be constantly monitored and shall be reviewed
at every construction and project management meeting

If, during construction, events that can present infection risks occur, intervention procedures
shall be implemented immediately to resolve the problems

Plumbing and HVAC systems shall be supplied, installed, and commissioned in accordance
with CAN/CSA-Z317.1, CAN/CSA-Z317.2, and CAN/CSA Z318.0

Before substantial completion and occupancy, the constructor shall have satisfied all infection
control measures. Detailed inspections shall be performed by the multidisciplinary team
After construction

In addition to preventative measures II and IIl before the completed construction area is
occupied any portions of the infection control plan still in effect shall be reviewed by the
multidisciplinary team.

If necessary such portions shall be incorporated into the healthcare facilities ongoing operating
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 15
policies and procedures.
Note: in this document the term “patient” is inclusive of patient, resident or client.
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 16
APPENDIX 4
Quick Reference Guide for CSA Z8000-11 Guidelines
Infection Prevention and Control & Facility Infrastructure Requirements
Infection Prevention & Control shall be involved from the design phase through to commissioning
in both new construction and renovations of existing facilities.
Canadian Standards Association (CSA) Standards shall be incorporated into all
construction/renovation projects. With renovations every effort shall be taken to follow the latest
CSA standards.
This includes:
1. CSA Z317.2 – 10: Special requirements for heating, ventilation, and air conditioning (HVAC)
systems in health care facilities, 2010.
2. CSA Z8000 – 11: Canadian health care facilities, 2011.
The need for facility renovations shall be identified by the mandatory use of the biennial audit tool Best
Practices for Hand Hygiene in all Healthcare Settings: Supplementary checklist for facilities and
infrastructure needed to support healthcare providers; Provincial Hand Hygiene Working Group –
Facilities/Infrastructure Team (2012)
Quick Reference Guide for CSA Z8000-11 Guidelines
Item
Airborne isolation rooms
(AIR)
Explanation
Each acute care facility shall have a minimum of one AIR
per inpatient unit unless a risk assessment demonstrates
otherwise
Allied Health Services
For complete information see pages >
Page
Page 94 (also
see page 26-27
of CSA Z317.210)
Page 244-247
Ambulatory Care
For complete information see pages >
Page 174-183
Ceilings
For complete information see pages >
Clause 11
Table of common requirements
Page 354, Page
361-362
Page 327-353
Clean supply/utility room


Page 329
Dialysis
Clean and soiled utility rooms shall be separate
Supplies shall be stored in mobile shelving that is
cleanable, smooth, non porous, and tolerant of
hospital disinfectants; or automated dispensers
 Equipment and supplies shall not be exposed to
direct HVAC air flow, or stored by windows
 See section on floors/walls/ceilings
For complete information see pages >
Dining Room
For complete information see pages >
Page 333
Electrodiagnostic
For complete information see pages >
Page 267-273
Note: in this document the term “patient” is inclusive of patient, resident or client.
Page 184-191
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 17
Services
Emergency
Examination/procedure/tr
eatment room
For complete information see pages >



A wall mounted hand hygiene sink shall be
located adjacent to the door along with a hand
hygiene station
Soiled linen hamper and soiled garbage
container shall be provided
Storage of supplies should be provided in closed
cupboards
Page 209-223
Page 333-335
Floors
For complete information see pages >
Page 359-361
Hand hygiene sinks
Dedicated hand hygiene sinks shall be provided
A hand hygiene sink is required:
 In each inpatient bedroom
 Where treatments/exams/assessments are
provided
 Locations designed for one patient: one sink
 Locations designed for three or more patients:
one sink per three patients, with 6 m. or less
between any patient and sink
 Inside(if plastic pipes used), or adjacent to each
diagnostic MRI room
 Stainless steel hand hygiene sinks shall be used
in areas handling radioactive materials
 In each soiled utility/soiled holding room
 In any food prep area
 Inside or within 6 m. of each nursing station
 Inside or within 6 m. of each staff lounge
 In medication preparation areas
 Within 6 m. of each laboratory work station and
within each work room
 Where soiled linen is handled
 Any area where hands are likely to be
contaminated
 In each airborne isolation room and each
anteroom
 For complete information on materials, size,
construction, location, controls, backsplash,
dispensers and hand dryers see pages >
 Sinks must have water supply & drainage
separate from hemodialysis piping
For complete information see pages >
Page 96-97
For complete information see pages >
Page 21-24, 9194
Page 22, 340342
Housekeeping closet
Infection Control general
information
Inpatient room


Shall be single bedded rooms, unless the
functional program, with supporting
documentation, demonstrates the necessity of a
two-bed arrangement
Shall have one washroom per patient
Note: in this document the term “patient” is inclusive of patient, resident or client.
Page 337-339
Page 186
Page 339
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 18
Inpatient isolation rooms
Inpatient washrooms
Laboratory
For complete information see pages >
For complete information see pages >
For complete information see pages >
Page 343-344
Page 342-343
Page 248-266
Laundry for Rehab and
LTC
Maternal and Newborn
For complete information see pages >
Page 344
For complete information see pages >
Page 128-135
MDR







Stainless steel is preferred for surface materials
Open hoppers shall be located away from staff
work areas and traffic areas
Ceilings shall be resistant to humidity, non
porous, non shedding, and shall be constructed
without fissures, open joints or crevices
Solid walls shall have a hard, smooth finish and
may be sealed in epoxy or spray painted
Flooring shall have integral coved base
Shelving shall be non porous, non shedding, and
easily cleanable
The top and bottom of storage carts shall be
solid
Page 311-325
Medical Imaging
For complete information see pages >
Page 278-284
Medication Room
For complete information see pages >
Page 345
Oncology
For complete information see pages >
Page 192-208
Operating Rooms and
Procedure Rooms
Pharmacy
For complete information see pages >
Page 224-243
The mixing of parenteral therapy solutions requires
special work stations and air handling
 Chemo prep requires negative pressure
 Sterile medication prep requires positive
pressure
 Anterooms are recommended
 Satellite pharmacy
Page 285-290
Respiratory
Cough inducing procedures require special room
requirements and air handling
Page 274-277,
347
Scrub sinks
Shall be provided where operative procedures are
performed including ORs, delivery rooms, endoscopy
suites, interventional radiology, and cardiac
catheterization suites
Page 97
Soiled utility room





Shall be separate from clean utility room
Separate hand hygiene sink shall be provided
No storage of clean equipment
May store patient waste disposal equipment and
stool/urine/vomit specimen supplies
Shall have human waste management system
Note: in this document the term “patient” is inclusive of patient, resident or client.
Page 348
Page 348-349
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 19


Surfaces – ceilings,
floors, walls, doors,
window, furniture
Tub/Shower room
Shall be smooth, non porous, seamless, resilient and
impact resistant, cleanable and compatible with facility
approved disinfectants, water impermeable


Waiting rooms


Walls
Washroom - public



Waterless hand hygiene
stations
Window treatments
Page 351-352
Zones shall be created so that the more
infectious persons are in a separate area
Public washrooms shall be provided in close
proximity
Page 352
Page 360-361
Toilet, sink, and paper towel dispensers shall be
hands free
Toilets with tanks shall not be used, due to risk of
condensation
Page 352
One washroom with toilet and sink for each
inpatient. A closed waste management
mechanism with hand hygiene sink shall be
installed where toilet not required (e.g. ICU,
NICU or nursery)
Each inpatient service shall be equipped with at
least one closed waste management system
Page 94-95
Waterless hand hygiene station shall be provided in each
of the following locations:
 All entrances and exits to the healthcare facility
 Immediately adjacent to the entrance of each
patient bedroom
 Immediately adjacent to the entrance of each
patient care area (e.g. exam or procedure room)
 Adjacent to the bedside at point of care unless
risk to patient
 Where Personal Protective Equipment (PPE) is
donned or doffed
Shall be mounted approximately 1 m. from floor and shall
be in compliance with fire regulation guidelines


Page 86 - 89
Shall have a hand hygiene sink at the
entrance/exit just inside room
Each room shall have storage space for supplies
and PPE
For complete information see pages >

Waste management
Splash protection shall be provided on walls near
water supply, sinks, or human waste
management system
PPE should be available
Shall provide storage for soiled linen, garbage,
and biohazard carts
Shall be durable and easy to clean
Blinds to external windows should be installed
Note: in this document the term “patient” is inclusive of patient, resident or client.
Page 97
Page 339
Page 356-357
Infection Prevention and Control
Section 10X – IX1000 (Construction & Renovation Guidelines)
Page 20
between double glazing
Note: in this document the term “patient” is inclusive of patient, resident or client.