Infection Control - Isolation
Infection Control Office:
I.
II.
Margaret Chambers – 373-1726, Beeper 417-3303
ISOLATION
A.
INTRODUCTION
Parkwest Medical Center follows an Isolation Policy based on the latest CDC Guidelines for
Isolation published in January 1996. The policy was approved by both the Infection Control
and Medical Executive Committees. The purpose of this policy and guidelines is to
provide a consistent hospital-wide policy to direct hospital employees and the medical
staff in the prevention of spread of microorganisms among themselves, patients, and
hospital visitors. It is a two-tiered system based on the use of “Standard Precautions” for all
patients, with additional transmission-based precautions used as needed for specific known
or suspected diseases. These additional isolation categories include:
1.
Airborne Isolation is for known or suspected TB and certain childhood diseases such
as chickenpox. A negative pressure room and a Personal Respirator are required.
2.
Droplet Isolation is for certain types of pneumonia and meningitis and influenza. Blue
molded mask required.
3.
Contact Isolation is for patients who have resistant organisms, have major draining
wounds, and in other special situations. Gloves are required upon room entry.
4.
Neutropenic Precautions are for patients who have low white cell counts. Usually
these people are on chemotherapy and their immune system is impaired.
B.
RESPONSIBILITIES:
1.
Physician
a.
Obtaining cultures and ordering the precaution(s) necessary to protect the
patient or prevent the spread of infection to others.
b.
Wearing proper barriers when entering the isolation room.
2.
Nursing Staff
a.
Completing a TB triage on all patients in the ECC with pulmonary
symptoms, and on all patients admitted to the hospital as found on the
nursing admission assessment form. (See Airborne Isolation)
b.
Initiating appropriate isolation precautions and correct procedures following
receipt of an order for isolation. (Use the isolation checklist)
c.
Informing the Infection Control office of initiation and discontinuation of
isolation.
d.
Ensuring the isolation procedures are carried out, i.e. wearing proper
barriers each and every time an isolation room is entered.
e.
Enforcing the isolation precautions with all personnel, patients, and families.
3.
Infection Control
a.
Be available to the nursing staff, medical staff, patient, and their family as
an informational resource.
b.
Report all communicable diseases to the Public Health Department as
required by law and document in the patients’ chart when completed.
c.
Act as liaison to be sure patients are placed in proper precautions.
OVERVIEW OF ISOLATION CATEGORIES
For each approved category, except for Standard Precautions, door/bed signage and/or chart
stickers are available and must be utilized.
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A.
STANDARD PRECAUTIONS
1.
A combination of elements from Universal Precautions and the old category of
Body Substance Isolation that applies to ALL patients.
2.
Applies to any contact with the any of the following:
a.
Blood
b.
ALL body fluids, including secretions and excretions, whether or not visible
blood is present.
c.
Non-intact skin
d.
Mucous membranes
3.
Nursing responsibilities:
a.
Perform hand hygiene with soap/water or hand sanitizer at entry/exit.
b.
Handle contaminated linen, sharps and contaminated waste appropriately.
c.
Use personal protective equipment.
i.
Gloves – Use when touching blood, body fluids, secretions,
excretions, contaminated items; for touching mucus membranes and
nonintact skin.
ii.
Gowns – Use when contact of clothing/ exposed skin with blood/body
fluids, secretions, or excretions is anticipated.
iii.
Mask and goggles or a face shield – Use during patient care
activities likely to generate splashes or sprays of blood, body fluids,
secretions, or excretions.
B.
AIRBORNE ISOLATION - Used in addition to Standard Precaution for patients with
known or suspected pathogens that may be transmitted by droplet nuclei.
1.
Diseases requiring Airborne Isolation:
a.
TB - Tuberculosis
b.
Rule out TB
c.
Measles (Rubeola)
d.
Varicella Zoster Virus
i.
Primary Varicella - Chickenpox
ii.
Disseminated Zoster or Shingles
e.
SARS
2.
TB Triage
a.
ECC Triage
i.
Pulmonary patients, and all patients noted to be coughing, will have
a brief screening performed upon presentation that asks “Have you
been coughing for two (2) weeks or greater and/or recently coughed
up blood?” If yes, then proceed with the following:
a.
Have you had loss of appetite?
b.
Have you had weight loss equal or greater than ten pounds?
c.
Have you had fever greater than seven (7) days?
d.
Have you had sweats and chills?
ii.
ECC Patients answering “Yes” to any of the above sub-questions will
be asked to cover coughs and sneezes (tissues will be provided).
a.
The ECC physician will be notified at once of the positive TB
screening.
b.
The chart will be marked with an airborne sticker.
c.
The patient will be placed in a negative-pressure private
treatment room. A standard private treatment room may be
used if no negative-pressure room is available.
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b.
3.
4.
5.
6.
Admissions Area Triage
i.
All patients noted to have cough will be given tissues and asked (“for
general hygiene”) to cover all coughs and sneezes.
ii.
Patients with cough will be moved through the admissions area as
quickly as possible and the accepting floor notified that further
screening, as per ECC Triage, shall be expeditiously completed.
c.
Floor Triage
i.
All patients not screened in the ER will be screened as part of the
initial nursing assessment, unless TB already suspected. The same
screen as used by ECC Triage will be employed. (See above)
ii.
Patients meeting criteria for suspected TB will be kept as separate
from other patients and staff as possible, using tissues to cover all
coughs and sneezes, until a final decision regarding isolation has
been made. The attending physician should be called immediately if
TB is suspected.
Transmissible Tuberculosis - Any case of TB meeting the following criteria:
a.
Active disease not yet on therapy; or
b.
Active disease on therapy, but less than 3 negative AFB smears (unless
exception approved by Hospital Epidemiologist), AND disease involves ANY
part of the upper or lower respiratory tract including mouth and pharynx;
urinary tract or draining wound.
Room Requirements - Negative Pressure Private Room: These rooms are ECC
1&3, 224, 232, 265, 312, 335, 365, 412, 433, 435, 465, 512, 535, CCU
14,15,16,17,18,&19, Bronchoscopy room, PACU isolation room, Autopsy room.
The door must be kept closed.
Barrier Requirements:
a.
All healthcare workers must wear a Personal Respirator to enter the room.
i.
Each healthcare worker must be fit tested for this by Occupational
Health Services or the designated person in your area. This is a
requirement for all healthcare workers who have the potential to
come in contact with an infected patient.
ii.
Respirator must be “fit checked” each time the healthcare worker
places his/her respirator on. Respirators are used for the entire shift
and then discarded.
iii.
When identifying the personal respirator, may place name on the
strap. Do NOT mark on the mask itself as it may ruin the integrity of
the mask.
b.
Visitors
i.
Should be instructed to wear a blue “molded” droplet mask. Visitors
are not permitted to wear respirators.
ii.
Children should not enter the room.
iii.
If family or visitors refuse to wear the mask, document in the nurses’
notes and notify Infection Control.
c.
Patient
i.
Upon leaving the room must wear an orange “barrier” mask.
ii.
Instruct the patient in the proper placement of the mask.
iii.
The patient must be able to tolerate the wearing of the mask for the
entire time he/she is out of their room.
Nursing Responsibilities:
a.
Obtain order from physician.
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b.
7.
C.
Isolation supplies
i.
Riverstone and ECC - Place respirators and blue molded masks just
outside at patient doorway.
ii.
Montvue - Place on respirators and blue molded masks on counter in
anteroom.
iii.
Critical Care – Place respirators and blue molded masks in nurse
server.
c.
Negative pressure room required – alarm system must be activated.
d.
Keep door closed at all times (even when the patient is temporarily out of
the room).
e.
Signage, educational materials and checklist are at nurse’s station.
f.
Place magnetic sign on door opening near room number.
g.
Label chart and complete isolation checklist.
h.
Limit the reason a patient is out of his room for essential purposes only.
i.
Perform hand hygiene with soap/water or hand sanitizer at entry/exit.
j.
Notify engineering for daily monitoring of the room air pressure to ensure
negative pressure as long as the room occupied and patient is in isolation.
k.
Upon discharge from the hospital, place time of discharge on the
housekeeping board. Wait sufficient time after patient discharge to enter
room without respirator. (See Airborne Pathogen Exposure Control Plan for
clearance times).
Patient Responsibilities:
a.
Covers mouth and nose when coughing or sneezing.
b.
Wears orange barrier mask to leave the room and leaves mask in place for
the entire time he/she must be out of the room.
DROPLET ISOLATION - Used in addition to Standard Precautions for patients with
known or suspected pathogens that may be transmitted by droplets.
1.
Diseases requiring Droplet Isolation:
a.
Influenza - Flu
b.
Rubella - German measles
c.
Meningitis either known or suspected to be caused either by the
Haemophilus Influenza (H Flu) bacteria or Neisseria Meningitidis
(Meningococcal) bacteria.
d.
Meningococcal Pneumonia
e.
Meningococcal Sepsis (Meningococcemia)
f.
Mumps
g.
Mycoplasma Pneumonia
2.
Room Requirements - Any private room. Co-horting of patient in semi-private room
is acceptable if both patients are at the same stage of the same illness.
3.
Barrier Requirements
a.
Employee/physician/visitor
i.
Wear blue “molded” droplet mask if within six feet of the patient.
ii.
Wear eye protection if performing task that would generate any
droplets if within 3 feet of patient.
iii.
The orange “barrier” mask may be substituted if the molded mask is
unavailable or does not provide a good fit for the employee.
iv.
Masks are to be discarded at the end of the shift. When identifying
the mask, may place name on the strap. Do NOT mark on the mask
itself as it may ruin the integrity of the mask.
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b.
4.
5.
Patient
i.
Upon leaving the room must wear an orange “barrier” mask.
ii.
Instruct the patient in the proper placement of the mask.
iii.
The patient must be able to tolerate the wearing of the mask for the
entire time he/she is out of their room.
Nursing Responsibilities:
a.
Obtain physician order.
b.
Isolation supplies
i.
Riverstone - Place blue molded masks just inside patient room on
counter.
ii.
Montvue – Place masks just outside at patient doorway.
iii.
Critical Care – Place masks in nurse server.
c.
Signage, educational materials and checklist are at nurse’s station.
d.
Place magnetic sign on door opening near room number.
e.
Label chart and complete isolation checklist.
f.
Limit the reason a patient is out of his/her room to essential purposes only.
g.
Perform hand hygiene with soap/water or hand sanitizer at entry/exit.
Patient Responsibilities:
a.
Covers mouth and nose when coughing or sneezing.
b.
Wears orange barrier mask to leave the room and leaves mask in place for
the entire time he/she must be out of the room.
.
D.
CONTACT ISOLATION - Used in addition to Standard Precautions for patients with
known or suspected infection or colonization with epidemiologically important
microorganisms that can be transmitted by direct contact with the patient.
1.
Diseases requiring Contact Isolation:
a.
Multi-drug resistant microorganisms e.g. Methicillin Resistant Staph Aureus
(MRSA), Vancomycin Resistant Enterococcus (VRE), Extended Spectrum
Beta-lactamase bacteria (ESBL)
b.
Clostridium Difficile Colitis
c.
Major draining abscesses or open wounds - Wounds that require irrigation,
or their drainage cannot be contained in a dressing, etc.
d.
Chickenpox
e.
Any gastroenteritis in a diapered or incontinent patient, e.g., -Salmonella,
Shigella, Campylobacter, and E Coli 0157:H7
f.
Herpes Simplex, mucocutaneous, disseminated or primary, severe
g.
Zoster, localized in immunocompromised patient, or disseminated
2.
Room Requirements - Any private room. Co-horting of patients in a semi-private
room is acceptable if both patients are at the same stage of the same illness.
3.
Barrier Requirements:
a.
Glove use as for standard precautions and WORN UPON ROOM ENTRY.
i.
These gloves need to be changed after contact with infective
materials (such as feces or wound drainage) and BEFORE contact
with environmental surfaces.
ii.
Gloves need to be removed before leaving the room and followed by
hand hygiene (use of waterless alcohol if hands are not visibly soiled
and washing with an antimicrobial soap if hands are visibly soiled).
Avoid contact with potentially contaminated environmental surfaces
or patient care items after completing hand hygiene.
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b.
4.
5.
E.
Gown use as for standard precautions, and worn upon room entry IF
substantial contact with clothing with the patient, environmental surfaces, or
patient care items is anticipated.
Nursing Responsibilities:
a.
Obtain physician order.
b.
Isolation supplies
i.
Riverstone - Pull supplies from list in computer scan and place
gloves on counter just inside door) and put other supplies in cabinet.
ii.
Montvue – Obtain isolation cabinet from Central Supply and place on
door to patient room.
iii.
Critical Care – Pull supplies from list in computer scan and place in
nurse server.
c.
Signage, educational materials and checklist are at nurse’s station.
d.
Place magnetic sign on door opening near room number.
e.
Label chart and complete isolation checklist.
f.
Put on gloves before entry into room.
g.
Wear gown if potential contact with contaminated surfaces.
h.
Hand hygiene with soap/water or hand sanitizer at entry/exit.
i.
Alert other departments of patient’s isolation status.
j.
Limit the reasons a patient is out of his/her room to essential purposes only.
k.
Dedicated noncritical patient-care equipment (e.g.: stethoscope, blood
pressure cuff, thermometer) should be used whenever possible.
l.
Common-use items must be adequately cleaned and disinfected between
patients.
m.
Daily cleaning and/or disinfection of environmental surfaces, frequently
touched items, and patient-care items.
For patients in contact isolation to leave the room, they must meet certain
requirements:
a.
Any dressing must be clean and dry or freshly changed.
b.
A clean cover gown must be put on the patient.
c.
The patient’s hands must be washed with an antimicrobial soap or use an
alcohol-based waterless antiseptic agent.
d.
Any patient care equipment that must accompany the patient must be
disinfected with a hospital-approved germicide.
e.
If transported, the stretcher or wheelchair must be lined with clean linen and
the transport vehicle disinfected with a hospital approved germicide after the
patient has been returned to the isolation room and before being used with
another patient.
f.
Patients in Contact Isolation due to gastrointestinal pathogens must be
continent and with minimal diarrhea to leave the room for ambulating
activities/treatments.
g.
Gloves must be worn for any direct patient contact.
NEUTROPENIC HOST PRECAUTIONS - Applies only to patients with absolute
granulocyte counts less than 1000 per cubic mm and replaces Protective or
Compromised Host Isolation. These precautions may be used in conjunction with any
other isolation type that may be required.
1.
Patients needing these precautions include:
a.
WBC less than 1,000.
b.
Patient receiving chemotherapy.
c.
Organ transplant patient receiving immunosuppressive steroids.
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6.
d.
Other immune conditions that physicians feel need protective isolation.
2.
Room Requirements:
a.
Private room required and positive pressure room is preferred (514, 415,
516 and 517). The door must be kept closed.
b.
If patient needs to be in airborne isolation, use the negative pressure rooms
with anteroom (512, 265, 365 or 465).
3.
Barrier Requirements:
a.
Persons with upper respiratory infections should not enter the room. If entry
is necessary, orange barrier masks must be worn.
b.
Persons with other infectious diseases (such as fevers, draining wounds,
herpetic lesions) should not enter.
c.
Patients should wear orange barrier masks if their care requires them to be
out of their rooms.
4.
Nursing Responsibilities:
a.
Isolation supplies
i.
Riverstone - Place orange masks just inside patient room on counter.
ii.
Montvue – Place just outside at patient doorway.
iii.
Critical Care – Place in nurse server.
b.
Signage, educational materials and checklist are at nurse’s station.
c.
Place magnetic sign on door opening near room number.
d.
Label chart and complete isolation checklist.
e.
Strict handwashing with antimicrobial soap or alcohol-based waterless
antiseptic agent before room entry and prior to any patient contact. This
applies to ALL visitors and staff.
f.
Restrict visitors to immediate family, if possible.
g.
NO live plants or flowers in room
h.
Do not remove ice pitcher from the room. Carry ice to room in a closed
paper or plastic bag.
i.
Remove soiled linen as soon as possible; do not keep hamper in room.
j.
Patient care equipment such as stethoscopes and blood-pressure cuffs
should be dedicated for use with a given patient under these precautions, or
disinfected between patient uses. Dedicated disposable equipment is
permitted.
k.
Instruct the patient in the proper placement and wearing of the orange
barrier mask if he/she leaves the room.
l.
Notify dietary department of Neutropenic Host Precautions because of the
following precautions:
i.
NO fresh fruits/vegetables in room.
ii.
NO uncooked salads, fruits, or vegetables on dietary trays, except
that freshly peeled unbruised fruits may be included IF served
promptly after peeling.
m.
Notify Engineering for daily monitoring of room air pressure to ensure
positive pressure.
Patient Responsibilities - Wear orange barrier mask to leave the room and leave mask in
place for the entire time he/she must be out of the room.
FOR MORE INFORMATION ON INFECTION CONTROL, PLEASE REFER TO SPECIFIC POLICIES
AND PROCEDURES
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