Download CDHA IC 04-008 Contact Precautions

INFECTION PREVENTION AND CONTROL MANUAL
Policy and Procedure
TITLE:
Effective Date:
Contact Precautions
(formerly Contact
Measures)
October 2012
Applies To:
All
NUMBER:
IC 04-008
Page
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POLICY
1. Routine Practices will be used in conjunction with Contact Precautions. (Refer to
Appendix A for the conditions, clinical presentations and specific etiologies requiring
Contact Precautions in addition to Routine Practices.)
2. Droplet and Airborne Infection Precautions, as applicable, will be used in conjunction
with Contact Precautions.
3. Every area is to have a system in place to identify patients with known or suspected
infections/conditions that require Contact Precautions.
4. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant
Enterococcus (VRE) patients (both infected and colonized) require single rooms
with a private bathroom.
DEFINITIONS
Contact Transmission:
The transference of microorganisms through physical contact
between an infected source and a host (direct contact) or
through the passive transfer of the microorganisms to a host via
an intermediate object (indirect contact).
GUIDING PRINCIPLES AND VALUES
1. Routine Practices properly and consistently applied will usually prevent transmission by
the contact route. For certain situations that may result in extensive contamination of the
environment or for microorganisms with a very low infectious dose (i.e. Norovirus),
Contact Precautions may be required.
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PROCEDURE
1. Implement Contact Precautions based on presenting signs and symptoms. Do not wait
for etiology to be confirmed.
2. Never take health records into the room or bed space of any patient, including those on
Contact Precautions.
2.1. Initiate a stool chart (CD0306MR) and place on the health record when Contact
Precautions are indicated for diarrhea.
Note: Ongoing assessment and documentation of stools for patients with diarrhea
is critical to determine patient status and requirements for continued Contact
Precautions.
3. Document the initiation and removal of Contact Precautions in the health record.
4. Notifications
Note: Any health care provider can implement Contact Precautions.
4.1. Notify Infection Prevention and Control and the Administration for the facility (after
hours) when initiating Contact Precautions for any unusual activity such as
increased number of potentially infected cases or potential outbreak situation.
5. Accommodation/Placement/Signage
Note: A private room with a private bathroom is preferred for most patients requiring
contact precautions, and required for MRSA and VRE positive patients (Refer to Policy
Statement # 4).The door to the private room may remain open.
5.1.
If a private room is not available, consider co-horting as follows:
5.1.1. When single patient rooms are limited, perform a risk assessment in
conjunction with an Infection Control Practitioner (ICP) to determine patient
placement and/or suitability for co-horting.
Note: Cohorting will only be done in conjunction with an ICP or the
Administrator on call for the facility (if after-hours).
5.1.2. Prioritize patients with conditions that may facilitate cross-transmission of
microorganisms for single patient room placement (e.g.: uncontained
drainage, stool incontinence, young age, and cognitive impairment).
5.1.3. Cohort patients who are infected or colonized with the same microorganism
and are suitable roommates. Select roommates for their ability and the ability
of their visitors to comply with required precautions.
5.1.4. Refer to Appendix B for a cohorting algorithm.
5.2. When cohorting is not feasible:
5.2.1. Avoid placing a patient requiring Contact Precautions in the same room as a
patient who is at high risk for complications if infection occurs or with
conditions that may facilitate transmission (e.g.: those who are
immunocompromised, or patients with open wounds).
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5.2.2. In a shared room, if a patient has diarrhea, assign a dedicated toilet or
commode to that patient.
5.2.3. In shared rooms, ensure all roommates and visitors are aware of the Contact
Precautions to follow. Select roommates for their ability and the ability of their
visitors to comply with required Contact Precautions.
5.2.4. If possible, close the privacy curtain between beds to minimize opportunities
for direct contact.
5.3. Dedicate a commode at the bedside for patient use in multi-bed rooms (use the
“Dedicated Commode” sign Prin A786).
5.4. Place a Contact Precautions sign at the entrance to the patient room if a private
room or over the head of the bed AND on the privacy curtains in multi-bed room (so
that sign is visible when curtains are pulled).
5.5. Place a Contact Precautions sign on the front of the patient’s health record.
5.5.1. Patients on Contact Precautions may use unit shower/tubs. Completely clean
and disinfect any equipment, e.g. shower, shower curtain, or tub/shower
chairs after patient use.
5.6. Put in place Droplet or Airborne Precautions signage (in addition to Contact
Precautions signage) as required.
6. Hand Hygiene
6.1. Follow the Four Moments for hand hygiene to prevent the transmission of infection.
6.2. Ensure a supply of alcohol based hand rub (ABHR) is available at the bedside for
patient and visitor use.
6.3. Instruct patients and visitors on the importance of proper hand hygiene techniques.
Use standardized IPAC educational materials such as those found on the IPAC
Intranet site or Capital Health patient education website.
6.4. Offer patients frequent opportunities to clean their hands; assist them with hand
hygiene as necessary.
7. Personal Protective Equipment (PPE)
7.1. Provide PPE for Contact Precautions outside the patient room for private rooms.
7.1.1. See Appendix C for the set up for an isolation cart.
7.1.2. Do not overstock the isolation cart.
7.1.3. Clean and disinfect isolation carts routinely and when visibly soiled.
7.1.4. Discard unused supplies and clean/disinfect the isolation cart following patient
discharge.
7.2. Change PPE and perform hand hygiene between contacts with all patients.
7.2.1. Refer to Appendix D for the correct sequence for applying and removing PPE.
7.3. Housekeeping staff members wear a gown and gloves for all entries into the
room/bed space of a patient on Contact Precautions (due to the nature of the work).
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7.4. In addition to the use of PPE as per Routine Practices other staff and physicians
wear:
7.4.1. Gloves
Always wear gloves to enter the patient room, cubicle or patient’s designated
bed space.
7.4.2. Gowns
When indicated by a point of care risk assessment (see Appendix E), wear a
long sleeved gown.
Apply before entering the room or bed space of the patient.
7.4.3. Mask/Protective Eye Wear
When indicated by a point of care risk assessment (see Appendix E), wear a
mask and/or eye protection.
Key Point: If a patient with MRSA has signs and symptoms of a respiratory
tract infection, wear a mask.
8. Patient Flow/Transport
Note: The ambulatory freedom of patients on Contact Precautions is restricted in order
to minimize the potential transmission of contact spread illness/microorganisms. (See
Table 1 for criteria for Out of Room Activity
8.1. Advise patients on Contact Precautions to leave their room only for medically
essential purposes.
8.2. Restrict patients on Contact Precautions from participating in pet therapy programs.
8.3. Ensure that patients are accompanied by a healthcare provider whenever outside of
the room, unless alternative arrangements have been agreed upon and
documented in advance with an ICP.
8.3.1. Refer to IC 04-013 Out of Room Ambulation for more details.
Table 1
The 5Cs - Criteria for Patient Out of Room Activity with Contact Precautions
Competent - The patient must be able to verbalize understanding of instructions.
Cooperative - The patient must be able to follow directions and engage in
treatment.
Contain - Any wounds should be covered. A mask should be worn if the patient
has respiratory symptoms.
Clean - Patient should wear clean robe/gown/clothes. The patient must wash
hands before leaving the room and be encouraged to use alcohol based hand
rub frequently.
Continent - The patient must be continent of urine and stool.
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Transport Procedures
8.4. Wear appropriate PPE while in the room/bed space and while preparing the
patient for transport (Refer to Procedure #7 - PPE).
8.5. Ensure that the patient cleans his/her hands before leaving the room.
8.6. Whenever possible, do not transport patients in their beds. Use a clean stretcher
or wheelchair draped with a clean linen sheet to minimize direct contact between
the patient and the transport device.
8.7. Transport the patient with clean bedding and ensure that wounds are covered with
clean dressings.
8.8. Remove and dispose of PPE and perform hand hygiene prior to transporting
patients.
8.8.1. Put on clean gloves for transport.
8.9. Put on clean PPE to assist the patient if necessary, during transport and at the
transport destination.
8.10. Patients do not wear PPE for transport or ambulating unless required by other
policies (i.e.:Droplet/Airborne).
8.11. Place the health record in a clear plastic bag.
Note: Patients should not routinely hold their own health records.
8.12. Advise the receiving area that the patient requires Contact Precautions as per
Transfer of Accountability protocols.
8.13. Clean and disinfect the transport device immediately after use.
8.14. Refer to Appendix F for a summary of transport steps.
9. Patients/Families/Visitors Education
9.1. Educate patients, families and visitors on Contact Precautions. Use appropriate
patient education materials
9.2. Advise visitors to:
9.2.1. clean hands before and after visiting.
9.2.2. if assisting with direct patient care, use the same personal protective
equipment as healthcare providers (i.e. gloves and a gown).
9.3. Refer to Contact Precautions “Rooming In” Guidelines for Family/Visitors IC 04-025
for those individuals who request to room in with a patient on Contact Precautions.
10. Management of Visitors
10.1. Advise visitors to speak with a nurse before entering the patient’s room.
10.2. Minimize the number of visitors to essential visitors only, with no more than two
(2) at a time.
10.3. Instruct visitors to:
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10.3.1. visit only one (1) patient. If the visitor must visit more than one patient,
instruct the visitor to use the same PPE as the healthcare providers and
perform hand hygiene before going to the next patient room/bed space.
10.3.2. to clean their hands before accessing unit fridges, ice machines etc.
10.3.3. refrain from visiting other areas of the hospital if possible.
11. Cleaning of the Patient Environment
11.1. Allow sufficient time for cleaning and disinfecting of rooms of patients/residents on
Contact Precautions.
11.2. Do not remove Contact Precautions signage from outside the room/over the bed
until the terminal clean has been completed.
11.3. Communicate to Housekeeping staff the type of Contact Clean required.
11.4. Housekeeping Staff Responsibilities
11.4.1. Follow established Housekeeping cleaning protocols.
11.4.2. Ensure awareness of the type of cleaning required for individual patients
on Contact Precautions, and seek clarification when necessary. (Refer to
Table 2 for the 3 categories of cleaning for Contact Precautions.)
Table 2
Three categories of cleaning for Contact Precautions
Contact Clean: a “regular” Contact Precautions clean and includes
patients colonized or infected with MRSA (or if being tested for MRSA and
results are not known prior to transfer or discharge).
Enhanced Clean: to be completed when a patient is infected or colonized
with VRE (or if being tested for VRE and results are not known prior to
transfer or discharge)
Enteric Clean: to be completed when a patient has diarrhea.
11.4.3. Remove the signage and return to the nursing station upon completion of
the terminal clean.
12. Linen
12.1. Place a laundry hamper in the single room or at the bedside of patients on
Contact Precautions if space allows.
12.2. Carefully roll soiled linen and place in the linen hamper. Minimize shaking of
soiled linen.
12.3. Double bag laundry into a clean bag for disposal only if the outside of the bag is
visibly soiled with blood or body substances.
13. Dishes
Note: Disposable dishes and cutlery are not required.
13.1. Dietary Staff Members Responsibilities
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13.1.1. Clean hands and wear clean gloves to drop off and pick up trays from
patients on Contact Precautions.
13.1.2. As Dietary Staff members do not set up patients for meals or clear space
for trays, bring the tray to the nursing desk for delivery by nursing staff if a
location to place the tray cannot be immediately found.
13.2. Place used trays from patients on Contact Precautions on tray carts if all
deliveries are completed and the carts are being returned to the dish room for
sanitizing.
13.3. If trays from patients on Contact Precautions are left after pick up by Food and
Nutrition staff, bag the tray and leave for pick up in a designated area.
14. Waste
14.1. Place a garbage receptacle in the single room or at the bedside of patients on
Contact Precautions if space allows.
14.2. Double bag waste into a clean bag for disposal only if the outside of the bag is
visibly soiled with blood or body substances.
15. Patient Care Equipment/Supplies/Medications
15.1. Dedicate equipment for use with patients on Contact Precautions or clean and
disinfect between patients.
15.2. Dedicate a commode at the bedside for patient use in multi-bed rooms (use the
designated commode sign Prin A786).
15.3. Refer to IC 08-001Cleaning and Disinfection of Non-Critical Patient Care
Equipment for more information.
15.4. Limit the amount of supplies taken into the patient’s room or bed space to prevent
wastage. Discard unused items such as dressing supplies, suction catheters,
syringes, linens, and paper goods upon transfer or discharge.
15.5. Have medications delivered and stored as per routine pharmacy procedures. (No
special measures are required for medications.)
16. Duration of Precautions
16.1. Always contact the Infection Prevention and Control department and consult an
Infection Control Practitioner before discontinuing Contact Precautions.
Note: Duration of Contact Precautions will be determined on a case-by-case
basis. Re-evaluate the patient with persistent symptoms for underlying chronic
disease. Repeated microbiological testing may sometimes be warranted.
16.2. For patients with C. difficile infection (CDI), confirm that the patient has been
symptom free (patient’s normal baseline stools) for 48 hours before discontinuing
Contact Precautions. (Refer to Procedure #16.1.)
16.3. Discontinue Contact Precautions for CDI only after the room/bed space and
bathroom have been terminally (Enteric Clean) cleaned.
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17. Handling of Deceased Bodies
17.1. Use Contact Precautions for handling deceased individuals, when Contact
Precautions were in place prior to death.
MODIFICATION OF CONTACT PRECAUTIONS FOR LONG-TERM CARE
18. Resident Placement, Accommodation and Activities
18.1. Perform a risk assessment (in conjunction with an ICP on a case by case basis) to
determine resident placement, removal from a shared room, or participation in
group activities. Consider the presence of risk factors that increase the likelihood
of transmission and the potential adverse psychological impact on the affected
resident when balancing infection risks to other residents.
18.2. Use appropriate signage when Contact Precautions are required (bedside and
health record).
Note: At the Veterans Memorial Building, this may consist of a green star/flower
on the door.
18.3. Restrict participation in group activities only if wound drainage or diarrhea cannot
be contained.
18.4. Ensure all residents perform hand hygiene (or are assisted as necessary) before
and after participation with group activities.
Rationale: Reduces the stigmatization of residents on Contact Precautions.
18.5. Refer to Appendix G, Modifications of Contact Precautions for Transitional Care
Units (TCUs), for Recreation Therapy.
19. Use of PPE
19.1. Wear gloves if direct personal care contact with the resident is required or if direct
contact with frequently touched environmental surfaces is anticipated.
19.2. Wear other PPE as per the point of care risk assessment. (Refer to Appendix E)
MODIFICATIONS OF CONTACT PRECAUTIONS FOR AMBULATORY CARE
20. Source Control
20.1. Triage patients promptly.
20.2. Minimize contact between symptomatic patients and others by minimizing time
spent in waiting rooms.
20.3. When possible, schedule symptomatic patients at a time when less likely to
encounter other patients.
20.4. Place in a separate room as soon as possible.
21. Cleaning and Disinfection of Patient Care Equipment and Patient Environment
21.1. Clean equipment and surfaces in direct contact with the patient or infective
material (e.g., respiratory secretions, stool or skin exudates) before the room is
used for another patient. Place contaminated reusable non-critical patient care
equipment in a plastic bag for transport to a soiled utility area for reprocessing.
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21.2. Clean all horizontal surfaces and frequently touched surfaces in the room prior to
use by another patient if the source patient is likely to cause extensive
environmental contamination (E.g.: diarrhea or fecal incontinence not contained
by diapers, copious wound drainage, copious uncontrolled respiratory secretions
or sputum).
22. Special Considerations for the Care of Patients with Antibiotic Resistant
Microorganisms in Ambulatory Care Settings
22.1. Adhere to modifications of Contact Precautions for ambulatory care as found in
Appendix H.
MODIFICATIONS OF CONTACT PRECAUTIONS FOR HOME CARE
23. Accommodation
23.1. Advise symptomatic patients to:
23.1.1. Rest away from others, in a separate room if available.
23.1.2. Use a dedicated bathroom, whenever possible.
23.1.3. Clean and disinfect the bathroom frequently, especially frequently touched
surfaces.
23.1.4. Not share towels or other personal items.
24. Patient Activity
24.1. Do not exclude asymptomatic patients from group/social activities.
24.2. Advise symptomatic patients how to contain secretions/excretions to minimize the
risk of transmission to others (e.g., contain draining wounds with an intact
dressing) and to perform hand hygiene prior to group activities.
24.3. Advise symptomatic patients to exclude themselves from group/social activities
when experiencing acute symptoms and when secretions/excretions cannot be
contained.
24.4. Reschedule care and services (e.g., appointments at foot care clinics, volunteer
visiting and volunteer transportation) that are not medically necessary, until clients
are asymptomatic.
25. PPE
25.1. Wear gloves and gowns when direct contact is anticipated with a symptomatic
patient or equipment and environmental surfaces in the patient’s immediate
environment.
26. Duration of Precautions
26.1. Discontinue precautions when patient is asymptomatic in the home care setting.
27. Special Considerations For The Care of Patients With Antibiotic Resistant
Microorganisms In Home Care
27.1. Notify the home care agency (completed by the health care provider making the
referral) when a patient is known to have an antibiotic resistant microorganism to
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ensure appropriate precautions are implemented. If asymptomatic, Routine
Practices properly and consistently applied are sufficient.
27.2. Do not use Contact Precautions for patients who are asymptomatic including
asymptomatic carriers of antibiotic resistant organisms; Routine Practices,
properly and consistently applied are sufficient.
MODIFICATIONS FOR MENTAL HEALTH SETTINGS
28. Patient Placement
28.1. Place in a single room with a private bathroom or dedicated commode chair. If a
single room is not available, a double room with use of dedicated commode or
designated bathroom may be utilized with privacy curtains.
29.
Inpatient Services: Nova Scotia Hospital, East Coast Forensic Hospital,
Abbie J. Lane
29.1. If a single room is not available, space isolation may be initiated:
29.1.1. Designate a commode chair to the patient or dedicate a toilet stall and
sink in shared facilities.
29.1.2. Place disinfectant wipes at the sink, clean and disinfect after use.
29.1.3. Disinfect shower and clean/replace shower drapes after patient use.
29.1.4. Advise the patient to shower last if possible.
29.1.5. If the patient is unable to remain in his/her room, monitor hand hygiene.
29.1.6. Prevent the patient from entering areas of food preparation (i.e;
kitchenette.)
30. Personal Protective Clothing (PPE)
30.1. Staff
30.1.1. Wear gloves for direct patient contact such as providing personal care to
the patient.
30.1.2. Determine the need for the use of a gown or other PPE based on a risk
assessment.
Note: In cases where there is only dialogue with no direct contact, careful
hand hygiene only, before and after the dialogue session, is indicated.
30.1.3. Hand hygiene is essential in preventing transmission. After any contact
with the patient, bedside equipment or other contaminated articles, clean
hands immediately.
30.2. Visitors
Note: No PPE is required unless direct personal care is being provided.
30.2.1. Direct visitors to clean hands before and after visiting.
31. Clinical Equipment
31.1. Keep necessary items in the patient’s room for the sole use of the patient
whenever possible.
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31.2. If necessary, store carts at the nursing station or designate an “isolation area” for
the protection and safety of other patients.
32. Meals
32.1. A patient who has an antibiotic resistant microorganism may eat in the unit dining
room under the following conditions;
32.1.1. The patient uses alcohol based hand rub (ABHR) before and after sitting at
the table for meals; staff provide assistance and directly observed.
32.1.2. Cover draining/open lesions, if any.
32.1.3. Separate the patient from others.
32.1.4. Clean and disinfect the chair after use.
32.1.5. Clean and disinfect the table after meals.
32.2. Staff members do not eat at the nursing station or in the patient dining area.
33. Respiratory Therapy Equipment
33.1. Dedicate aerosol equipment to the patient; (I.e: nebulizer, tubing and masks.)
Keep in a locked area, or area designated as area for use by this patient only.
Clean and disinfect after use with disinfectant wipes.
34. Electroconvulsive Therapy (ECT) Guidelines
34.1. Schedule MRSA/VRE patients as the last case of the day.
34.2. Notify the ECT unit prior to patient transport to the ECT unit.
34.3. The ECT unit/staff members:
34.3.1. Remove all unnecessary equipment.
34.3.2. Receive the patient directly into the treatment room.
34.3.3. Gown and glove to administer treatment.
34.3.4. Use disposable equipment when indicated; send non disposable items to
Dartmouth General Hospital for reprocessing
REFERENCES
The Public Health Agency of Canada. (2010). Routine Practices and Additional Precautions
for Preventing the Transmission of Infection in Health Care.
Infection Prevention and Control Nova Scotia. Department of Health and Wellness (2012).
Best Practice Guidelines for Reducing Transmission of Antibiotic Resistant Organisms
(AROs) in Acute & longer Term Care settings, Home Care & Prehospital Care.
RELATED DOCUMENTS
Policies
IC 04-013
IC 04-011
IC 04-010
Out of Room Ambulation policy
Droplet Precautions
Airborne Infection Precautions
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Contact Precautions IC 04-008
IC 04-025
IC 08-001
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Contact Precautions “Rooming In” Guidelines for Family/Visitors
Cleaning and Disinfection of Non-Critical Patient Care Equipment
Forms
CD0306MR Stool Chart
Appendices
Appendix A - Conditions, Clinical Presentations and Specific Etiologies Requiring Contact
Precautions (In Addition To Routine Practices)
Appendix B – Contacts Precautions Co-horting
Appendix C – Isolation Cart Set-up
Appendix D - Sequence for Applying and Removing Personal Protective Equipment
Appendix E – Point of Care Risk Assessment
Appendix F – Transport Protocol – Patients on Contact Precautions
Appendix G – Additional Recreation Therapy Guidelines for 4B – VG site
Appendix H – Antibiotic Resistant Microorganism Guidelines for Ambulatory Care
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Appendix A
Conditions, Clinical Presentations and Specific Etiologies Requiring Contact
Precautions (In Addition To Routine Practices)
Conditions/Clinical Presentation
Based on Signs and Symptoms
All patients with diarrhea (gastroenteritis):
Until infectious cause ruled out
Major wound infection, abscess or infected
pressure (decubitus) ulcer, cellulitus or other
skin infection if drainage cannot be
completely contained by dressings
Extensive desquamating skin infection, until
S.
aureus infection ruled out
Skin infection, (draining) not contained by a
dressing
Skin rash, compatible with scabies
Skin rash, vesicular in appropriate
epidemiologic context until smallpox and
monkeypox ruled out
Hemorrhagic fever, acquired in appropriate
endemic area
Meningitis
Other Considerations
Routine Practices are the base upon
which additional precautions are applied.
Note: Droplet or Airborne Infection
Precautions may also be required.
Diarrhea is defined as new onset diarrhea (3
or more loose stools in 24 hours) and no
likely non-infectious cause (e.g. pre-existing
condition or laxative use).
Diarrhea is liquid stool-if poured into a
container, it conforms to the shape of the
container.
Use Contact Precautions for children who
are unable to comply with hand hygiene
requirements, appropriate handling and
disposal of purulent discharges and skin
exudates, and maintain dressings in place.
Use Contact Precautions for children who
are unable to comply with hand hygiene
requirements, appropriate handling and
disposal of purulent discharges and skin
exudates, and maintain dressings in place.
Use Contact Precautions for children who
are unable to comply with hand hygiene
requirements, appropriate handling and
disposal of purulent discharges and skin
exudates, and maintain dressings in place.
Until 24 hours after initiation of appropriate
treatment.
Use Airborne Infection Precautions as well.
Local public health authorities must be
notified (for smallpox and monkeypox).
Use Airborne Infection Precautions as well,
if pneumonia.
Local public health authorities must be
notified.
Use Droplet Precautions as well (for children
and adults) until 24 hours after initiation of
appropriate treatment.
Use Contact Precautions in children less
than 5 years of age due to possible
enteroviral meningitis (i.e. children who are
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Contact Precautions IC 04-008
All suspected or confirmed respiratory tract
infections until viral infection ruled out:
• Asthma, febrile
• Bronchiolitis
• Colds
• Croup
• Influenza-like illness
• Pneumonia
• Pharyngitis
Specific Etiology (Microorganism
Specific)
Antibiotic-resistant microorganisms
MRSA
VRE
Multi Resistant Gram Negative Bacteria
B. cepacia respiratory tract colonization or
infection in patient with cystic fibrosis
Gastroenteritis:
All cases: C. difficile, norovirus and rotavirus
*Child or incontinent adult:
Campylobacter
E.coli (0157:H7 and other strains)
Giardia
Salmonella
Shigella
Yersinia
Adenovirus, other enteric viruses
Diptheria, cutaneous
Enteroviral infections (child)
Hepatitis A, E
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incontinent or unable to comply with hand
hygiene requirements).
Not indicated for older children who are
continent and able to comply with hand
hygiene
Use Droplet Precautions as well
Other Considerations
Routine Practices are the base upon
which additional precautions are applied.
Note: Droplet or Airborne Precautions
may also be required.
Infection or asymptomatic (i.e., colonization)
When asymptomatic, precautions are not
required in prehospital and home care.
Includes MRSA, VRE, Gram-negative
bacteria and other organisms as per
Infection Prevention and Control policy.
Consider Contact Precautions for
incontinent adults if stool cannot be
contained or for adults with poor hygiene
who contaminate their environment.
Use Contact Precautions for children who
are incontinent or unable to comply with
hand hygiene requirements.
Not indicated for older children who are
continent and able to comply with hand
hygiene.
Use Contact Precautions for children who
are incontinent or unable to comply with
hand hygiene requirements.
Consider Contact Precautions for
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incontinent adults if stool cannot be
contained or for adults with poor hygiene
who contaminate their environment.
Herpes simplex virus (neonatal or
disseminated
mucocutaneous)
Pediculosis (Lice)
Head, body, pubic
Polio, acute infantile paralysis
Rubella, congenital (German Measles)
Scabies
Smallpox, monkeypox, generalized vaccinia
and
eczema vaccinatum
Staphylococcus aureus skin infections:
• major wound or skin infection where
drainage
is not contained by a dressing
Streptococcus group A skin infections
• major wound or skin infection where
drainage
cannot be contained by dressing
• all cases of severe *invasive streptococcal
disease or toxic shock syndrome
Vaccinia (eczema vaccinatum or
disseminated
vaccinia)
Varicella zoster virus
• Varicella (chickenpox)*
• Shingles (zoster)
-disseminated*
-localized (immunocompromised
host)*
-localized normal host
Viral hemorrhagic fevers: Lassa, Ebola,
Marburg, Crimean-Congo and others
Please refer to body of text for further
details.
Viral respiratory tract infections
• Adenovirus
• Bocavirus
• Coronavirus
• Human metapneumovirus
Until 24 hours after an appropriate
pediculocide has been applied according to
the manufacturer’s instructions.
Local public health authorities must be
notified.
Use Droplet Precautions as well.
Immune healthcare workers only.
Local public health authorities must be
notified.
Until 24 hours after initiation of treatment.
Use Airborne Infection Precautions as well.
Local public health authorities must be
notified.
Use Droplet Precautions as well until 24
hours after initiation of appropriate
treatment.
*Local public health authorities must be
notified.
Local public health authorities must be
notified.
Varicella immune healthcare workers
*Use Airborne Infection Precautions as well.
Use Airborne Infection Precautions as well,
if pneumonia.
Local public health authorities must be
notified.
Use Droplet Precautions as well.
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Contact Precautions IC 04-008
•
•
•
•
•
•
Page 16 of 25
Influenza
Parainfluenza virus
Rhinovirus
Respiratory syncytial virus
Severe acute respiratory syndrome
Coronavirus (SARS Co-V )
Reference: The Public Health Agency of Canada. (2010). Routine Practices and Additional
Precautions for Preventing the Transmission of Infection in Health Care
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APPENDIX B
Contact Precautions Cohorting (placing in the same room)
Patient infected/colonized with the same lab confirmed microorganism?
NO
YES
Consider Cohort
Patient suitable to have
roommate? No open
wounds? Able to comply
with precautions?
Do not Cohort
NO
Do not Cohort
YES
Cohort
Must only be done in consultation with Infection Prevention and Control.
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APPENDIX C
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APPENDIX D
Sequence for Applying and Removing Personal Protective Equipment (PPE)
The PPE chosen depends on the anticipated risk for exposure to contaminated surfaces or
blood and body substances/fluids.
Application (order is
not critical)
Clean hands
1. Gown
3. Protective eyewear
Clean hands with soap and water or an alcohol-based hand rub.
A long sleeved gown is applied with opening at the back and is tied
at neck and waist to cover exposed skin and clothing.
If gown is too small, wear two gowns. Gown one ties in front and
gown two in back.
Mask is placed over nose, mouth and chin.
Adjust the flexible nose piece to fit.
Secure with ties or elastics.
Adjust to fit comfortably.
4. Gloves
Select correct type and size. Extend gloves over gown cuff.
2. Mask
(when required)
Removal (order
important)
1. Gloves
2. Gown
3. Protective eyewear
4. Mask
Clean hands
Pinch outside edge of glove near wrist.
Peel away from hand, turning glove inside-out.
Hold in opposite gloved hand.
Slide ungloved finger under cuff of the remaining glove.
Peel off from inside, creating a bag for both gloves.
Discard.
Unfasten ties.
Peel gown away from neck and shoulders.
Pull arms out (gown will turn inside out).
Fold or roll into a bundle.
Discard.
Clean hands.
Grasp ear of head pieces.
Lift away from face.
Place in designated receptacle for reprocessing or disposal or
disinfect at point of care.
Untie the bottom, then top tie, and remove from face by the ties. Do
not grasp the front of the mask. Remove a procedure mask by
grasping the elastic bands around the ears.
Discard.
Clean hands with soap and water or an alcohol-based hand rub.
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APPENDIX E
Point of Care Risk Assessment:
Before every patient interaction ask yourself:
What task am I doing?
What are the patient’s symptoms?
What is my risk of exposure to blood, body fluids, excretions, secretions, non-intact
skin & mucous membranes?
What is my skill level for this task?
How cooperative is the patient?
What is the environment where I will be performing this task?
What actions do I need to take?
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APPENDIX F
Transport Protocol - Patients on Contact Precautions
1. When possible, prior to transport, have the patient wash his/her hands or use an alcohol
based hand rub.
2. Staff will wear gloves and a gown for close transfers from the bed to the transport vehicle.
3. Wrap (swaddle) the patient in a clean blanket or sheet to contain them during transport.
4. Remove gloves, gown and wash hands or use alcohol based hand rub.
5. Put on clean gloves, pick up the chart, and transport the patient to destination.
6. Ensure the health record has a Contact Precautions sign securely fastened to the chart
cover.
7. To avoid contamination of the health record, enclose it in a clear plastic bag if placing it on
the stretcher or giving it to the patient to hold for transport.
8. Notify the receiving department to advise that the patient is in transport to them.
9. Decontaminate the stretcher or wheelchair immediately after use to avoid crosscontamination to others. Use a hospital approved disinfectant.
10. Discard plastic bag chart cover appropriately.
11. Clean hands.
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APPENDIX G
February/2011
Additional Recreational Therapy
Guidelines for Nursing Unit 4B
These guidelines are intended to accompany the Infection Control/ Recreation Therapy
Group/Individual Participation Guidelines for Patients under MRSA Precautions
The following guidelines have been approved for Nursing Unit 4B only
These guidelines are not to be considered applicable to any other unit
Any patient with MRSA/VRE, or a patient positive for Vancomycin Resistant
Entercoccus (VRE) will need to be assessed by the Infection Prevention and Control
Practitioner on a case by case basis
1. The Infection Prevention and Control Team do NOT need to be consulted for every
patient entered in every recreation therapy activity as long as the participation
guidelines are followed. Any patient under additional precautions (such as isolation for
VRE, enteric measures, droplet precautions, etc. will require a consult with the
Infection Prevention and Control Practitioner
2. Patients who cannot independently understand and follow infection control guidelines
may participate in programs provided they can successfully follow guidelines when
cued by staff
3. Patients may participate in food based programs as long as the infection prevention
and control guidelines are adhered to
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APPENDIX H
ANTIBIOTIC RESISTANT MICROORGANISM (ARO) POSITIVE PATIENTS
in Capital Health Ambulatory Care Settings
General Infection Prevention and Control (IPAC) Recommendations
These recommendations are for outpatients in ambulatory care settings. They are
not for use on the inpatient units. These do not apply to Endoscopy, Minor
Procedures and Emergency Department areas.
*Note: inpatient precaution guidelines are to be followed when seeing inpatients on
precautions in ambulatory care settings.
Definition: ARO (antibiotic resistant microorganism) Carrier - a patient with MRSA
and/or VRE who is “flagged” with an Infection Control alert in the STAR/PHS patient
registration system or offers a history of MRSA and/or VRE colonization/infection identified
outside of CDHA. Note for clerks: Infection Control alerts are only visible in STAR/PHS, not
GUI. Ensure STAR/PHS registration is completed prior to the patient being seen.
Preamble:
Precautions taken in ambulatory care settings are situation dependent and based on a
risk/benefit assessment. This assessment takes into consideration the type and duration of
patient/ health care worker interaction, the medical condition of the patient, responsible use
of resources, and need to maintain efficient patient flow.
Underlying Principles:
Maintaining the dignity, privacy, and confidentiality of every patient must be
paramount when implementing IPAC recommendations.
All patients presenting to reception/registration should clean their hands on arrival
with alcohol based hand rub (ABHR).
o Signage should be clearly displayed to convey this message to all
patients/visitors.
o Staff should remind patients to clean their hands upon entry/exit to the area.
AROs such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycinresistant enterococci (VRE) are spread by contact. If a patient or a health care
worker’s hands have not touched something, they are not contaminated.
o Supplies in patient care rooms should be kept to a minimum at all times.
o Select supplies needed for immediate use with clean hands or clean gloves.
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
Page 24 of 25
Supplies are not to be touched with soiled hands or gloves (in order to
prevent cross-contamination).
o Privacy curtains in patient care rooms are not to be handled with
contaminated hands or soiled gloves. Curtains are changed on a rotating
schedule and when visibly soiled.
ARO contacts are cared for in the ambulatory care setting using Routine Practices.
These are patients flagged in the *STAR system as “contacts”.
o * If possible, collect requested specimens (contact IPAC if clarification
required).
Recommendations:
After registration, MRSA/VRE positive patients (carriers) go directly to a patient care
room, if possible.
o Note, once the patient’s hands are clean the risk of ARO transmission from a
clean and fully clothed patient (who does not have uncovered draining
wounds etc…) in a waiting room setting is considered negligible.
o If a patient does sit in a public waiting area (fully clothed with wounds
covered) it is not necessary to clean or disinfect the chair afterwards. Routine
scheduled environmental cleaning is sufficient.
o Waiting areas should have a ready supply of ABHR, tissues and a garbage
receptacle(s). Signage should be in place in waiting areas regarding the
importance of hand hygiene.
o If magazines are kept in waiting areas, they should be discarded when visibly
soiled and at regular intervals. Binders or protective coverings on magazines
are not recommended unless they can be cleaned. Toys are not
recommended. Refer to the Capital Health IPAC Position Statement on Toys
and Magazines in Waiting Areas.
If a patient must undress, a disposable patient belongings bag should be provided
for their clothing and personal effects if required. Communal lockers may then be
used (if applicable).
ARO carriers may use the public washrooms in the area. The washroom does not
need to be put out of service and no enhanced cleaning by Housekeeping is
required unless there is visible soiling.
A Contact Precautions sign may be placed on the patient care room door to
communicate this patient’s ARO status to members of the health care team.
Charts may be brought into the patient care room provided they are placed in a
designated clean area and are handled with clean hands only.
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A point of care risk assessment is conducted by the health care provider(s). This is
done to determine the nature of the health care interaction and the likelihood of
personal contamination and/or contamination of the care environment.
o Gloves are worn by health care providers when touching the patient and as
per Routine Practices.
o Masks are worn as per Routine Practices i.e. as an element of Personal
Protective Equipment (PPE).
o Determine if a gown is required as part of the point of care risk assessment.

Gowns are used to protect health care providers’ exposed skin and
clothing from contamination.

In general, gowns are worn for dressing changes, physical
examinations, direct physical assistance, and other procedures
requiring close contact at the point of care.
Dedicate equipment for use with this patient (e.g. a blood pressure cuff,
stethoscope, etc…).
Post Visit/Cleaning Procedures:
Responsibility for cleaning is area and resource specific. It may be done by clinic staff
and/or Housekeeping Services.
1. Touch surfaces (that have been contaminated during patient care) and equipment
used during the visit require thorough cleaning and disinfection following the visit.
Use a regular hospital approved cleaner/ low level disinfectant and appropriate PPE.
a. Examples of touch surfaces and equipment – arms of chair, doorknob,
examining table, stethoscope, and B/P cuff.
2. In general, basic cleaning can be delegated to a member of the care team (i.e. the
Clinic Aide if applicable) and if clinic resources permit.
3. If gross soiling of the room or washroom has occurred, Housekeeping Services are
required.
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