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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 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 Lesions in the respiratory tract 5 7 6 4 5 3 10 Norovirus 6 Streptococcus Pyogenes (Group A Strep) Respiratory 8 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 Group 3 High Risk Group 4 Very High Risk 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