Isolation Precautions:
Guidelines for Perioperative
Services
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What are Isolation Precautions?
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Practices that prevent transmission of certain
diseases from patients to staff, and from staff to
other patients
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Type of isolation precautions is determined by how a
disease is transmitted (passed)
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Isolation Precautions are done in addition to Standard
Precautions and include:
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Strict adherence to hand hygiene
Personal protective equipment (PPE) appropriate for the type
of isolation precautions in place
Environmental disinfection
Special air handling for tuberculosis
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I - Contact Precautions
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Contact Precautions
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Contact Precautions apply to diseases
transmitted by direct contact with the
patient’s skin and/or infectious substance
and by indirect contact with the patient’s
environment
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Gloves and gowns are used
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Masks are used in certain circumstances
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Diseases Requiring
Contact Precautions
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Clostridium difficile
Congenital rubella
Lice
Scabies
Large wounds
Burn patients in ICU
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Specific Information on
Acinetobacter
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Acinetobacter is a group of bacteria commonly found
in soil, water, food, and sewage
Loves the GI tract – the “gut” flora/bug
May also be found on the skin of healthy people,
especially healthcare workers
Resulting infections are often resistant to many
commonly prescribed antibiotics – treatment may be
limited to very toxic drugs
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Specific Information on
Acinetobacter
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Acinetobacter can be spread to susceptible
individuals through direct person-to-person
contact, contact with contaminated surfaces,
or exposure in the environment
Bacteria can survive for days on inanimate
objects such as mattresses, bedrails, IV
poles, computer keyboards, and phones
Also may colonize in the nose or on hands
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Specific Information on
Acinetobacter
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Outbreaks of Acinetobacter may occur in ICUs and in
other hospital units that house patients with weakened
immune systems or chronic illnesses
May cause pneumonia, bloodstream or urinary tract
infections, and skin/wound infections
Endocarditits, secondary meningitis, and ventriculitis
may also result
Patients placed on Contact Precautions for Acinetobacter
infection remain on isolation precautions throughout their
hospitalization
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Specific Information
on MRSA
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Methicillin-resistant Staphylococcus aureus (MRSA)
is the commonly called “staph” bacteria that has
become resistant to many antibiotics
Patients who have invasive procedures, lengthy
hospital stays, weakened immune systems, or who
receive dialysis are at increased risk of developing
MRSA
Community-acquired MRSA (CA-MRSA) is increasing
among patients who have never been hospitalized
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Specific Information
on MRSA
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About 30% of the US population have “staph”
bacteria that normally live on the skin and in nasal
passages without causing harm (colonized)
Common infections caused by MRSA include skin
abscesses, boils, and impetigo
More serious infections that may develop include
deep soft tissue abscess, blood stream infections,
pneumonia, endocarditis (heart valves, inner lining of
the heart), and toxic shock
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Specific Information
on MRSA
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MRSA is spread by worker hands that pick up the
bacteria from skin-to-skin contact with a
colonized or infected patient, then care for
another patient without first performing
adequate hand hygiene
Contact with contaminated substances or items
such as computer keyboards, bedrails, or medical
equipment can also lead to transmission
MRSA may survive for weeks to months on
various surfaces!
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Specific Information
on VRE
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Enterococci bacteria are normally found in the
human intestines, the female genital tract, and
the environment and may not cause disease
Vancomycin is a drug commonly used to treat
enterococci infections. In some instances the
bacteria is resistant to the drug and is therefore
called vancomycin-resistant entercocci (VRE)
Patients can be colonized or have an active
infection involving the urinary tract, blood stream
or wounds
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Specific Information
on VRE
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Risk factors for developing VRE include: persons
previously treated with vancomycin or combinations of
other drugs, persons receiving prolonged antibiotic
therapy, weak immune system, surgery to abdomen or
chest, and use of indwelling catheters
VRE is spread by direct contact with infected stool,
urine, or blood containing VRE
Can also spread indirectly by hands or via contaminated
environmental surfaces
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Circulator Responsibilities for a
Contact Precautions Case
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Post the RED Contact Precautions sign on the OR
door, along with the red “No Traffic” sign
Ensure that all staff don gloves, gowns, and masks
before the patient enters the OR
Inform the receiving department of the patient’s
isolation status prior to transferring the patient!
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II - Airborne Precautions
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Airborne Precautions
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Airborne Precautions apply to diseases transmitted
by the airborne route
Bacteria or viruses are released into the air when
an infected patient talks, coughs, or sneezes
These droplets float on air currents and/or remain in
the air for long periods of time
A susceptible person who does not wear respiratory
protection can breathe in the droplets and potentially
become infected
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Diseases Requiring
Airborne Precautions
1. Pulmonary Tuberculosis (TB)
2. Measles
3. Chicken Pox
Unusual bioterrorism agents and others such as …
- Smallpox (Bioterrorism)
- Viral hemorrhagic fevers
(Bioterrorism)
- SARS
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Patients are placed on droplet precautions when any of these
diseases are suspected or confirmed
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N-95 Respirators
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ALL STAFF providing care to patients on
Airborne Precautions must wear an
N-95 respirator!!
N-95 respirators must be fit tested annually
by Vanderbilt Environmental Health and
Safety (VEHS) – your mask size can change
over time
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Airborne Precautions
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Post the blue Airborne Precautions sign on the OR
door before the patient arrives, along with the
red “No Traffic” sign
Patients coming to the OR who are on Airborne
Precautions should be scheduled as the last case of
the day whenever possible
Limit traffic through the OR during the case
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Airborne Precautions
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Patients should be placed in negative pressure rooms
while on their designated floor/unit
Keep the door closed!!!
Limit transport of patient from room except for
essential purposes
Have the patient wear a regular surgical mask any
time they are transported from their room
Inform the receiving department of the patient’s
isolation status prior to transferring the patient
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Airborne Precautions Responsibilities for
Anesthesia Providers
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Non-ICU patients on Airborne Precautions will be
recovered in the OR after the completion of the surgical
procedure – not in PACU!
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ICU patients may be recovered in a negative pressure room
on their assigned unit
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The patient will then be transported back to their designated
floor/unit
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Anesthesia machine filters will be changed out after the case
(same procedure as for any case)
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Airborne Precautions Responsibilities for
OR Charge Nurses
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When an Airborne Precautions case is
boarded, the OR Charge Nurse will order the
portable HEPA Unit from Central Supply so
that it will be ready to use immediately after
the case
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Airborne Precautions Responsibilities for CT-I Staff
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After patient leaves the
OR, bring in the HEPA
Unit
Place HEPA Unit in the
center of the OR, away
from the return air vent
Plug HEPA Unit into
electrical outlet and
turn the Unit “on”
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Allow HEPA Unit to run
for ONE HOUR before
cleaning the room
OR may then be cleaned
with standard
germicidal agent
Portable
HEPA Unit
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III - Droplet Precautions
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Droplet Precautions
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Applies to diseases transmitted by close
contact with respiratory secretions
Infectious droplets are expelled when a
patient coughs or sneezes
Droplets remain airborne for about 3 feet,
then fall to the floor
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Diseases Requiring
Droplet Precautions
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Influenza
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Pertussis (Whooping Cough)
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Mumps
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Meningitis caused by
meningiditis
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Fifth Disease (Parvovirus B-19)
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Patients are placed on droplet precautions when any of these
diseases are suspected or confirmed
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H. influenzae or N.
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More on Droplet Precautions
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Post the green Droplet Precautions sign on the OR
door, along with the red “No Traffic” sign
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Limit traffic through the OR during the case
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Wear a regular surgical mask when providing patient
care – not an N-95 respirator
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More on Droplet Precautions
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Wear gloves when handling items
contaminated with respiratory secretions
Wash hands after removing gloves
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More on Droplet Precautions
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After the patient leaves the OR/PACU/etc., the room
can be cleaned with the standard germicidal agent
Patients should be placed in private rooms while on
their designated floor/unit, but negative pressure
rooms are unnecessary
During transport, patients wear a regular
surgical mask
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Common Tasks for
ALL Isolation Precautions Cases
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The following slides describe steps
that are taken for every case
involving isolation precautions
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Scheduling any
Isolation Precautions Case
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Surgeon or resident boards the case
Surgery scheduler determines whether or not the patient
is on isolation precautions (if uncertain, scheduler contacts
the patient care unit)
Surgery scheduler documents isolation status in ORMIS,
which feeds onto the eOR board and the electronic
White Board
There are 4 possible choices for isolation status:
- None
- Airborne
- Droplet
- Contact
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Circulator Responsibilities for any
Isolation Precautions Case
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Post the appropriate
“Isolation Precautions” sign
and the “No Traffic” sign on
OR door
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Ensure all needed supplies
and equipment are available
in the OR
Remove all unnecessary
equipment from the OR
before the case begins
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Ensure ALL staff involved in
the case don gown, gloves,
and masks before the patient
enters the OR (if patient is
on airborne precautions, use
N-95 respirators instead of
surgical masks)
Isolation Cart with gowns,
gloves and other isolation
supplies is kept outside the
OR door
Close all cabinets (cannot
open cabinets during the
case!)
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OR Charge Nurse Responsibilities
for any Isolation Precautions Case
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Assigns a “runner” to the OR, who will
assist in obtaining additional supplies
for the case (this person will NOT
enter the OR at any time!)
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Anesthesia Provider Responsibilities
for any Isolation Precautions Case
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When transporting a patient direct to the OR:
-don appropriate PPE prior to entering
patient’s room
- assess patient’s condition and equipment
needed for transport
- conduct handoff with bedside nurse, including
verification of the patient’s isolation status
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Responsibilities for Other Staff
Assisting with Transport to the OR
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Don PPE prior to entering the patient’s room
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Verify the patient’s isolation status with the bedside nurse
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Team places a clean sheet over the patient
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Place patient charts in a plastic bag (obtain a plastic Isolation
Bag from the yellow Isolation Cart)
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Place monitors, charts, etc. on top of the clean sheet for
transport to the OR
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Have a “clean” person available (one who has not touched the
patient or patient’s bed/belongings) to push elevator buttons
and open doors
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During the Case…
Responsibilities for CT-I Staff
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Saturate a rag with germicidal disinfectant agent and
wipe down patient’s bed in hallway (includes mattress,
side rails, headboard and footboard)
Wait 10 minutes for the bed to dry – place an
isolation bag on bed during the drying phase so others
know it belongs to a patient on isolation precautions
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Make patient bed as usual
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Drape bed with clear plastic
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Put isolation sign on bed
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Communication Regarding
Return of Patient to the Unit
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Circulator calls unit charge nurse to inform them of
impending transfer and verifies isolation status
Anesthesia provider calls report to the patient’s
bedside nurse and verifies isolation status
Circulator conducts “rolling call” to unit as the patient
leaves the OR
Unit receives call and notifies charge nurse and
bedside nurse that patient is in transit and verifies
isolation status
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Responsibilities for Staff Assisting
with Transfer Back to the Unit
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All staff involved in patient
transport don new PPE
before transfer begins
Have a “clean” person
available (one who has not
touched the patient or
patient’s bed/belongings) to
push elevator buttons and
open doors
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Transport monitors and
other equipment are wiped
down with a germicidal
disinfectant agent before
leaving the patient’s room
Staff remove PPE prior to
exiting patient’s room
Anesthesia provider and
bedside nurse conduct
report/handoff and verify
isolation status
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After the case
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The OR should be cleaned with germicidal
disinfectant agent according to normal
standards
All linen and trash from the room are handled
in the same manner as from any case
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Questions or Concerns?
Contact
Infection Control & Prevention
Phone: 60725
Pager: 835-1205
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