Shiawassee County Medical Care Facility
Reviewed 12/6/12 (SME)
Isolation Precautions, Categories of
Policy Statement
Transmission-based isolation precautions will be used for residents who are documented or suspected to
have infections or communicable diseases that can be transmitted by airborne or droplet transmission or by
contact with dry skin or contaminated surfaces. Transmission based isolation precautions are to be used in
addition to Standard Precautions.
Policy Interpretation and Implementation
1.
2.
3.
4.
Transmission-based isolation precautions have been established in order to assure that appropriate
isolation techniques are implemented in this facility when necessary.
There are three types of transmission based isolation precautions: Airborne, Contact, and Droplet.
In addition to Standard Precautions, Airborne Precautions must be implemented for a resident
documented or suspected to be infected with microorganisms transmitted by airborne droplet
nuclei (small particle residue [5 microns or smaller in size] of evaporated droplets containing
microorganisms that remain suspended in the air and can be widely dispersed by air currents
within a room or over a long distance.)
**The facility does not have appropriate rooms for airborne isolation precautions. If a
resident needs airborne isolation, the physician must be notified and the resident needs to be
sent to the hospital. The criteria below for isolating does not apply at the facility.
a. Examples of infections requiring Airborne Precautions include, but are not limited to:
1) Measles
2) Varicella (including disseminated zoster)
3) Tuberculosis
b. Resident Placement
1) Place the resident in a private room that meets the following criteria:
a) Monitored negative air pressure in relation to the surrounding areas;
b) A minimum of six air exchanges per hour;
c) Appropriate discharge of air outdoors or monitored high efficiency
filtration of room air before the air is circulated to other areas of the
facility.
2) Keep the room door closed and the resident in the room.
3) When a private room is not available, residents with the same active infection
with the same microorganism, but with no other infection may be cohorted.
c. Respiratory Protection
1) Respiratory protection is required when entering the room of a resident with
known or suspected infectious tuberculosis.
2) Do not enter the room of residents known or suspected to have measles
(rubeola) or varicella (chickenpox) if susceptible to these infections.
d. Resident Transport
1) Limit movement of resident from the room to essential purposes only.
2) If transport or movement is necessary, minimize resident dispersal of droplet
nuclei by placing a surgical mask on the resident.
e. Signs- Color coded signs will be used to alert staff of the implementation of isolation
precautions, while protecting the privacy of the resident. Blue is the color code for
Airborne Precautions
1) .A blue sign instructing visitors to report to the nurses’ station before entering
should be placed at the doorway.
2) A blue sticker (without writing on it) should be place on the wall above the
head of the resident’s bed and on the front of the resident’s chart.
In addition to Standard Precautions, Contact Precautions must be implemented for residents
known or suspected to be infected or colonized with microorganisms that can be transmitted by
direct contact with the resident or indirect contact with environmental surfaces or patient-care
items in the resident’s environment.
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Shiawassee County Medical Care Facility
Reviewed 12/6/12 (SME)
a.
b.
c.
d.
e.
f.
g.
Examples of infections requiring Contact Precautions include, but are not limited to:
1) Gastrointestinal, respiratory, skin, or wound infections or colonization with
multidrug-resistant bacteria;
2) Clostridium difficile;
3) Enterohemorrhagic Escherichia coli 0157:H7;
4) Shigella;
5) Hepatitis A;
6) Rotavirus;
7) Diphtheria (cutaneous);
8) Major (noncontained) abscesses, cellulitis, or decubiti;
9) Pediculosis;
10) Scabies;
11) Zoster (disseminated or in the immunocompromised host).
Resident Placement
1) Place the resident in a private room.
2) When a private room is not available, residents with the same infection with
the same microorganism, but with no other infection may be cohorted.
3) When a private room is not available and cohorting is not achievable,
maintain spatial separation of at least 3 feet between the infected resident and
other residents and visitors.
Gloves and Hand washing
1) In addition to wearing gloves as outlined under Standard Precautions, wear
gloves (clean, nonsterile) when entering the room.
2) During the course of caring for a resident, change gloves after having contact
with infective material that may contain high concentrations of
microorganisms (fecal material and wound drainage.)
3) Remove gloves before leaving the room and wash hands immediately with an
antimicrobial agent.
4) After glove removal and hand washing ensure that hands do not touch
potentially contaminated environmental surfaces or items in the resident’s
room.
Gown
1) In addition to wearing a gown as outlined under Standard Precautions, wear a
gown (clean, nonsterile) when entering the room if you anticipate that your
clothing will have substantial contact with the patient, environmental surfaces,
or items in the patient’s room, or if the resident is incontinent, has diarrhea, an
ileostomy, a colostomy, or wound drainage not contained by a dressing.
2) Remove the gown before leaving the resident’s environment.
3) After gown removal, ensure that clothing does not contact potentially
contaminated environmental surfaces.
Resident Transport
1) Limit movement of resident from the room to essential purposes only.
2) If the resident must be transported from the room, ensure that precautions are
maintained to minimize the risk of transmission to other residents and
contamination of environmental surfaces or equipment.
Resident-Care Equipment
1) When possible, dedicate the use of noncritical patient-care equipment items
such as a stethoscope, sphygmomanometer, bedside commode, or electronic
rectal thermometer to a single resident (or cohort of residents) to avoid sharing
between residents.
2) If use of common items is unavoidable, then adequately clean and disinfect
them before use for another resident.
Signs- Color coded signs will be used to alert staff of the implementation of isolation
precautions, while protecting the privacy of the resident. Orange is the color code for
Contact Precautions.
1) An orange sign instructing visitors to report to the nurses’ station before
entering should be placed at the doorway.
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Shiawassee County Medical Care Facility
Reviewed 12/6/12 (SME)
5.
6.
7.
8.
In addition to Standard Precautions, Droplet Precautions must be implemented for a resident
documented or suspected to be infected with microorganisms transmitted by droplets (largeparticle droplets [larger than 5 microns in size] that can be generated by the resident coughing,
sneezing, talking, or the performance of procedures.)
a. Examples of infections requiring Droplet Precautions include, but are not limited to:
1) Invasive Haemophilus influenza type b disease including meningitis,
pneumonia, epiglottitis and sepsis;
2) Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and
sepsis;
3) Invasive multidrug-resistant Streptococcus pneumonia disease, including
meningitis, pneumonia, sinusitis, and otitis media;
4) Diphtheria (pharyngeal);
5) Mycoplasma pneumonia;
6) Pertusis;
7) Influenza;
8) Mumps;
9) Rubella.
b. Resident Placement
1) Place the resident in a private room.
2) When a private room is not available, residents with the same infection with
the same microorganism, but with no other infection may be cohorted.
3) When a private room is not available and cohorting is not achievable,
maintain spatial separation of at least 3 feet between the infected resident and
other residents and visitors.
c. Masks
1) In addition to Standard Precautions, wear a mask when working within 3 feet
of the resident.
d. Resident Transport
1) Limit movement of resident from the room to essential purposes only.
2) If transport or movement is necessary, minimize resident dispersal of droplets
by masking the resident.
e. Signs- Color coded signs will be used to alert staff of the implementation of isolation
precautions, while protecting the privacy of the resident. Yellow is the color code for
Droplet Precautions.
1) A yellow sign instructing visitors to report to the nurses’ station before
entering should be placed at the doorway.
See policy entitled Initiating Isolation Precautions in this chapter for the policy regarding the
implementation of isolation precautions.
In-service training will be provided upon employment and at least annually for all staff on the
categories of isolation precautions.
Staff is to contact the infection control nurse when questions arise.
Regulatory Reference Sources
42 CFR References
Survey Tag #s
Other
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483.65(b)
F442
CDC’s Draft Guidelines for Isolation Precautions in Hospitals