Download explanation of new standardized (nc) statewide isolation - nc

NEW STANDARDIZED (NC) STATEWIDE ISOLATION PRECAUTION SIGNAGE
North Carolina is the first state to have a “voluntary” unified color scheme for isolation
signage which will be available to be used across the spectrum of healthcare providers in
the state, including acute care hospitals, rehabilitation and long-term care facilities, and
ambulatory/surgical centers. The timing is right with the recently released revisions in
late June of the Centers for Disease Control and Prevention (CDC) Guideline for
Isolation: Preventing Transmission of Infectious Agents in Healthcare Settings 2007,
prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC).
First published in 1970, the CDC “Isolation Techniques for Use in Hospitals” was
designed for the acute care setting only. The latest revision for the first time addressed
all levels of healthcare from the most critical acute care to extended care, ambulatory and
home care settings. The use of isolation signage has been a standard recommendation by
the CDC as a tool for communicating the procedures that healthcare workers (HCW) and
family or visitors should follow to prevent cross-transmission. From 1970 to 1998 the
CDC had six isolation categories for all recognized communicable diseases and
infectious organisms. Sample color coded information signs for each isolation category
were included in the guidelines until the 1983 revision. Hospitals then began designing
their own isolation signage and modifying colors as they desired. Some healthcare
facilities chose to purchase commercially made signs. Over time, a myriad of colors,
language and symbols for isolation signage have been created by individual healthcare
facilities.
The situation today is that patients, families and visitors are in many different healthcare
facilities through referrals or as they access care. Medical, nursing, pharmacy and allied
health students typically train in multiple healthcare systems. In addition, turnover is
high in healthcare fields and moonlighting of staff between facilities is common. The
reality is everyone must remember the colors each facility has chosen to use for each of
the isolation categories. A statewide standardized color scheme could decrease
confusion, reduce the need for re-education among facilities and increase compliance.
An example can be found in a comparison of the three triangle healthcare systems: Duke,
UNC and Wake. The most frequently used category is Contact Precautions, which is
used when patients are recognized to be infected or colonized with multi-drug resistant
organisms like MRSA, C difficele or scabies. For that category, Duke uses orange, UNC
uses blue and Wake uses yellow. UNC uses yellow for airborne and droplet while Duke
and Wake use green for airborne and blue for droplet.
In March 2006, after discussion with the two prominent infection control groups in the
state, the Association for Professionals in Infection Control (APIC) North Carolina state
chapter and the Public Health and Institutional Task Force for Best Infection Control
Practice (PHIT force), a survey was sent to all acute care healthcare facilities infection
control professionals asking them to list their color scheme and the reason for choosing it.
A second email survey was sent to APIC-NC members in November 2006, with an
additional 31 respondents for a total of 55 facility responses. At the 2007 spring
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educational meeting of APIC-NC and the 2nd quarter June meeting of PHITFORCE, the
results of the survey and a sample color scheme for isolation signage was presented.
The results of the survey demonstrated that the majority of hospitals were using the
following color schemes: airborne – blue (55%), contact – orange (38%), and droplet –
green (53%). One modification to the three category isolation precaution system is for
patients with C difficele infections. Because C difficele becomes a spore when it is
released into the environment, additional hand hygiene methods are recommended: a
separate orange-colored contact sign is available that includes a brown box with the
recommendation to “wash hands with soap and water before exiting patient’s room.” The
rational is to physically remove any potential contamination that cannot be killed by hand
hygiene products.
In addition, the sign for special airborne diseases, which is CDC-recommended for use
with SARS, a Novel Influenza strain, or other highly infectious respiratory diseases, will
be yellow with red lettering. The Protective Environment (PE) was updated by the CDC
and emphasized that it is for patients with allogeneic hematopoietic cell transplants only.
Protective or Reverse Isolation precautions have not been demonstrated to be efficacious
for other patient populations (i.e. long-term steroid use).
The Statewide Program for Infection Control and Epidemiology (SPICE) has modified
isolation signage used at UNC hospitals to include the recommended changes to the
revised CDC guidelines to “don the indicated personnel protective equipment (gowns,
masks, gloves) upon entry into the patient’s room for patients who are on Contact and/or
Droplet Precautions since the nature of the interaction with the patient cannot be
predicted with certainty and contaminated environmental surfaces are important sources
for transmission of pathogens.”
The SPICE signs are available and encouraged for use in all North Carolina healthcare
facilities, although use is voluntary. Healthcare facilities may choose to use the color
scheme only, or to modify the statewide signage per facility policy.
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