Download Isolation Prioritisation Scoring System

Isolation Prioritisation Scoring System
This Isolation Prioritisation Scoring System should be used to allocate single room isolation facilities where
demand exceeds availability. Patients with conditions with a lower score still require isolation and should be
isolated as soon as a single room is available. For specific guidance on isolation and specific infectious diseases
please refer to the appropriate section in the Control of Infection Manual. Where an individual has multiple
scores then the highest score should be used to determine isolation priority.
Infection Control Team
Version 3
October 2014
1
MRSA
Areas
 HDU/ICU/NNU
 Oncology/haematology
 Orthopaedics/Vascular/Renal
MRSA Category
Mupirocin Resistance
Skin Shedders e.g. eczema,
psoriasis
Isolation Score
8
Specific Guidance
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
DATIX must be completed if unable to isolate patient
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
8
DATIX must be completed if unable to isolate patient
Sputum – colonised
Multiple sites colonisation
(exc. Sputum)
Clinical Risk Assessment (CRA*)
Applicable to all the above apart from
NNU here patients are only screened on
transfer from another health board
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Dermatology
Gynaecology/Obstetrics
General Surgical
Ophthalmology/Urology
Acute Care of the Elderly
General Medical
Non Acute Hospital – GP units
Paediatric wards (exc. NNU)
Rehab/Elderly Continuing Care
Mental Health/Learning Disabilities
Addiction Services
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
7
Uncovered wound site
Nasal colonisation only
*Clinical Risk Assessment
positive (yes to any question)
4
3
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
Isolate until the admission screen result is reported, if the result is
negative discontinue isolation, if the result is positive isolate until 2
negative Full MRSA screens taken on consecutive weeks
Mupirocin Resistance
8
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
DATIX must be completed if unable to isolate patient
7
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
Sputum – colonised
Multiple sites colonisation
(exc. Sputum)
5
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
Uncovered wound site
Nasal colonisation only
Clinical Risk Assessment
positive (yes to any question)
4
3
Mupirocin Resistance
8
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
Isolate until the admission screen result is reported, if the result is
negative discontinue isolation, if the result is positive isolate until 2
negative Full MRSA screens taken on consecutive weeks
Isolate until 2 negative Full MRSA screens taken on consecutive weeks
Skin Shedders e.g. eczema,
psoriasis
4
DATIX must be completed if unable to isolate patient
Assess risk – isolate if there is a significant risk to other patients
3
Do not nurse in adjoining beds to patients with wounds or invasive devices
Assess risk – isolate if there is a significant risk to other patients
Skin Shedders e.g. eczema,
psoriasis
Sputum – colonised
Multiple sites colonisation
(exc. Sputum)
Uncovered wound site
Nasal colonisation only
N/A
Do not nurse in adjoining beds to patients with wounds or invasive devices
Isolation not required. Do not nurse in adjoining beds to patients with
wounds or invasive devices
2
Infectious Diseases
Acute viral encephalitis incl. HSV
AIDS/HIV
Isolation Score
2
2
Bordatella Pertussis (Whooping Cough)
10
Campylobacter
Carbapenamase Producing
Enterobacterciae (CPE)
Chickenpox
2
11
Ante/Post Natal/Neonatal wards
10
Oncology/immunocompromised
patients
10
Clostridium difficile
8
8
Coronavirus
8
Novel Coronavirus
11
Cryptosporidium
Ebola (see Viral Haemorrhagic Fever)
Notifiable disease
E. Coli O157 – Notifiable disease
2
11
Extended Spectrum Beta Lactamase
producing (ESBL) organisms
Gastro-intestinal Infection (suspected
infectious diarrhoea / vomiting)
Gentamycin resistant, extended
spectrum beta-lactamase resistant
(ESBL)organisms
4
All other areas
9
8
Oncology/Immunocompromised
patients
8
Others Areas
Haemophilus Influenza (Type B)
Hepatitis (suspected viral)
6
10
3
Hepatitis B&C
Uncontrolled bleeding
Hepatitis A&E
Infectious mononucleosis
7
3
3
Specific Guidance
AIDS patients with specific infections see specific guidance. Consult with
Infection Control Nurse (ICN)/Consultant Microbiologist re isolation. For
clinical advice contact the Consultant Infectious Diseases (ID) Physician
or the Blood Borne Virus (BBV) Specialist Nurse.
Contact Infection Prevention & Control Team (IPCT) for further advice and
review staff and patient contacts
Multi-drug resistant organism. Contact IPCT for further advice. Clearance
criteria will be determined by Consultant Microbiologist
More infectious than shingles
Infectious until all lesions are dry and crusted – usually up to 7 days
following first crop of vesicles – longer in the immunocompromised
Isolate until asymptomatic for 48 hours and has had a normal bowel
movement
DATIX must be completed if unable to isolate patient within 2 hours
Contact IPCT and refer to relevant guidance
Blood & body fluids are highly infectious. See Viral Haemorrhagic Fever
(Ebola) Guidance
Isolate immediately if patient has diarrhoea
DATIX must be completed if unable to isolate patient
Dependant on site of body and where patient is placed within the hospital.
External site e.g. catheter is more likely to spread.
Isolate immediately if patient has diarrhoea and await specimen result
DATIX must be completed if unable to isolate patient within 2 hours
Dependant on site of body and where patient is placed within the hospital.
External site e.g. catheter is more likely to spread. Greater risk of spread
in ITU
Until patient has received 24 hours of appropriate antibiotics
Only hepatitis A requires isolation. This should be for the first week
following the onset of jaundice.
Isolation only required where risk of body fluid contamination of others or
the environment.
Only for first 7 days following onset of jaundice
3
Influenza (clinical diagnosis)
Intestinal parasites (incl. protozoans)
Legionellosis (legionnaires disease)
Lice
Isolation period 5 days from
onset of symptoms except in
immunocompromised individuals
– advice here should be sought
from the Consultant
Microbiologist of PCIT
8
2
N/A
3
Measles - Notifiable disease
Meningitis (undiagnosed - viral or
bacterial) - Notifiable disease
Cough
8
No cough
Meningococcal septicaemia
Mumps - Notifiable disease
Penicillin-resistant Streptococcus
pneumoniae
Respiratory syncytial virus (RSV)
Rotavirus
Rubella - Notifiable disease
Salmonella or shigella
3
4
8
8
Scabies
Scarlet Fever
Shingles
 Vesicle fluid
4
4
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Lesions in the respiratory tract
5
7
6
4
5
3
10
Norovirus
6
Streptococcus Pyogenes (Group A
Strep)
 Respiratory
8
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Bacteraemia, meningitis, wound,
CSF or other normally sterile
site – Notifiable disease
Single patient room when available or cohort only on advice of infection
control team or microbiologist; avoid placement with high-risk patients;
mask patient when transported out of room; Duration of precautions for
immunocompromised patients cannot be defined; prolonged duration of
viral shedding (i.e. for several weeks) has been observed
Isolation not required
Transmission is difficult unless there is head to head contact. Some lice
are resistant to treatment and these cases should be isolated. Bedding
and clothing should also be treated as infected.
Only immune staff should have contact with patient
All meningitis cases should be isolated until cause is established.
Meningococcal meningitis requires isolation until patient has received 48
hours of appropriate antibiotic therapy.
Remain in isolation until 48 hours of appropriate antibiotic therapy given
Only immune staff should have contact with patient
Cohorting may be required during periods of high seasonal activity
Note:- Risk to non immune individuals and pregnant women
Isolate until asymptomatic for 48 hours has had a normal bowel
movement
Less infectious than chickenpox. Non-immune staff should avoid direct
contact with lesions
Non-immune staff should avoid direct contact with lesions. Contact IPCT
and review staff and patient contacts
The isolation of Norovirus patients during some outbreak situations may
take priority. In the event of outbreak situation, contact the IPCT for advice
on isolation/cohorting affected patients.
Usually isolation until 24 hours of appropriate antibiotics, however, if
patient has respiratory symptoms continue isolation until asymptomatic
8
Contact IPCT for further advice
4
Suspected infected diarrhoea and / or
vomiting
Mycobacterium tuberculosis (TB) multi
drug resistant (MDRTB) - Notifiable
disease
Mycobacterium tuberculosis (TB)
pulmonary or laryngeal disease Notifiable disease
Mycobacterium tuberculosis (TB) extrapulmonary - Notifiable disease
Vancomycin Resistant enterococcus
Viral Haemorrhagic Fever - Notifiable
disease
6
11
TRANSFER IMMEDIATELY TO THE ID UNIT - MDRTB patients should
remain in isolation during hospital stay.
9
Isolate for period 14 days following commencement of appropriate
antibiotic therapy.
N/A
4
11
Isolation not required except if carrying out aerosol generating activities at
positive site
Duration of precautions will depend on the positive site
Blood & body fluids are highly infectious TRANSFER TO HIGH
SECURITY INFECTIOUS DISEASE UNIT (Royal Free Hospital,
London)
5
Isolation Prioritisation for Patients at Risk of Developing Infection during Construction Activity
Risk Group
Group 1
No evidence of Risk
Group 2 Increased Risk
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Group 3
High Risk
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Group 4
Very High Risk
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Patient groups
All patients not listed in Groups 2 – 4 below
Specific Guidance
Standard Infection Control Precautions (SICPs)
Patients on prolonged courses of high dose
steroids particularly those hospitalised for
prolonged periods
Severely immunosuppressed AIDS patients
Patients undergoing mechanical ventilation
Patients having chemotherapy who are not
neutropenic**
Dialysis patients
Neutropenia for less than 14 days following
chemotherapy
Adult acute lymphoblastic leukaemia (ALL) on
high dose steroid therapy
Solid organ transplantation
Chronic Granulomatous Disease of Childhood
(CGDC)
Neonates in Intensive Care Units (ICU)
Allogeneic bone marrow transplantation
o during the neutropenic period
o with graft versus host disease
Autologous bone marrow transplantation, i.e.
during the neutropenic period
Peripheral stem cell transplantation, i.e. during
the neutropenic period
Non-myeloablative transplantation
Children with severe combined immunodeficiency syndrome (SCIDS)
Prolonged neutropenia for greater than 14 days
following chemotherapy or immunosuppressive
therapy
Aplastic anaemia patients
Patients are usually dispersed throughout the hospital and, therefore,
physical protection may be impractical. Consideration should be given to
moving patients away from the construction area.
Patients should receive protection if the area of treatment is juxtaposed,
or near the hospital construction area or if it is otherwise likely that
Aspergillus-contaminated air may enter the area. High-risk patients should
be nursed in a ward with sealed windows and
suitable air quality
Patients should receive maximum protection irrespective of the type/size
of the building programme. All very high-risk patients should be nursed in
HEPA filtered positive pressure rooms during the neutropenic period. If
they are subsequently transferred to a ward the windows should be sealed
and suitable air quality provided
6