Hospital Infection Prevention And Control Guidelines For Isolation Precautions

National Centre For Disease Control, Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India came out with Hospital Infection Prevention And Control Guidelines. Following are its major recommendations for Isolation Precautions.

Introduction

Isolation precautions are needed to prevent the transmission of pathogenic microorganisms within the healthcare setting.

The patients of following disease categories should be treated under isolation.

Severe influenza cases, Subacute respiratory Syndrome (SARS), Open case of tuberculosis, Anthrax, diphtheria, Pertussis, Pneumonic plague, Chicken pox, and patients infected with multidrug resistant bacterial pathogens.

Patient placement

- Appropriate patient placement is a significant component of isolation precautions.

Determine patient placement based on the following principles:

-Route(s) of transmission of the infectious agent

- Risk factors for transmission in the infected patient

- Risk factors for adverse outcomes resulting from healthcare-associated infection in other patients in the area.

- Availability of single-patient rooms

- Patient options for room-sharing

Contact Precautions

1. Required for patients with enteric infections, diarrhea that cannot be controlled, or skin lesions that cannot be contained.

2. Patient placement:

a) Place patients who require Contact Precautions in a single-patient room when available; if single-patient rooms are unavailable, then place patients infected with the same pathogen in the same room.

b) If it becomes necessary to place a patient who requires Contact Precautions in a room with a patient who is not infected or colonized with the same infectious agent:

i) Avoid placing patients on Contact Precautions in the same room with patients who have conditions that may increase the risk of adverse outcome from infection or that may facilitate transmission.

ii) Ensure that patients are physically separated (i.e., >3 feet apart) from each other. Draw the privacy curtain between beds to minimize opportunities for direct contact.

iii) Change protective attire and perform hand hygiene between contacts with patients in the same room, regardless of whether one or both patients are on Contact Precautions.

3. Use of personal protective equipment

a) Wear gloves whenever touching the patient’s intact skin or surfaces and articles in close proximity to the patient. Don gloves upon entry into the room or cubicle.

b) Wear gown whenever anticipating that clothing will have direct contact with the patient or potentially contaminated environmental surfaces or equipment in close proximity to the patient. Don gown upon entry into the room or cubicle. Remove gown and observe hand hygiene before leaving the patient-care environment.

4) Patient transport

a) Limit transport and movement of patients outside of the room to medically-necessary purposes. b) When transport or movement in any healthcare setting is necessary, ensure that infected or colonized areas of the patient’s body are contained and covered.

c) Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions.

d) Don clean PPE to handle the patient at the transport destination.

5. Patient-care equipment and instruments/devices

a) Handle patient-care equipment and instruments/devices according to Standard Precautions

b) Use disposable noncritical patient-care equipment (e.g., blood pressure cuffs) or implement patient dedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient.

6) Environmental measures

a) Ensure that rooms of patients on Contact Precautions are prioritized for frequent cleaning and disinfection with a focus on frequently-touched surfaces and equipment in the immediate vicinity of the patient.

Droplet precautions:

1) Required for patients known or Suspected to be infected with pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking, Acute respiratory infection, undiagnosed or meningitis and/or sepsis with petechial rash .

2) Patient placement:

a) Place patients who require Droplet Precautions in a single-patient room when available; if single-patient rooms are unavailable, then place patients infected with the same pathogen in the same room.

b) If it becomes necessary to place a patient who requires Droplet Precautions in a room with a patient who does not have the same infection:

i) Avoid placing patients on Droplet Precautions in the same room with patients who have conditions that may increase the risk of adverse outcome from infection or that may facilitate transmission.

ii) Ensure that patients are physically separated (i.e., >3 feet apart) from each other. Draw the privacy curtain between beds to minimize opportunities for direct contact.

iii) Change protective attire and perform hand hygiene between contact with patients in the same room, regardless of whether one or both patients are on Droplet Precautions.

3) Use of personal protective equipment

a) Don a mask upon entry into the patient room or cubicle.

4) Patient transport

a) Limit transport and movement of patients outside of the room to medically-necessary purposes. b) When transport or movement in any healthcare setting is necessary, instruct patient to wear a mask and follow Respiratory Hygiene / Cough Etiquette.

c) No mask is required for persons transporting patients on Droplet Precautions.

Airborne precautions:

1) Required for patients known or suspected to be infected with infectious agents transmitted person-to-person by the airborne route, such as M. tuberculosis, measles, chickenpox, disseminated herpes zoster.

2) Develop systems (e.g., triage, signage) to identify patients with known or suspected infections that requires Airborne Precautions upon entry into the health facility.

3) Patient placement

a) Place patients who require Airborne Precautions in an airborne infection isolation room (AIIR) that has been constructed with the following conditions

i) Provides 6-12 air changes per hour.

ii) Directs exhaust or air to the outside, or through HEPA filters if exhausting to the outside is not possible.

iii) Has a monitor for air pressure with visual indicators.

iv) Can be closed with a door when not required for entry and exit.

b) If an AIIR is not available and transfer to a facility with AIIR is not possible, place a surgical mask on the patient and place him/her in a single room. Once the patient leaves, the room should remain vacant for the appropriate time, generally one hour, to allow for a full exchange of air.

c) Instruct patients with a known or suspected airborne infection to wear a surgical mask and observe Respiratory Hygiene/Cough Etiquette. Once in AIIR, the mask may be removed.

4) Personnel restrictions

a) Restrict susceptible healthcare personnel from entering the rooms of patients known or suspected to have measles, varicella, disseminated zoster, or smallpox if other immune healthcare personnel are available.

5) Use of personal protective equipment

a) Healthcare personnel should use a fit-tested respiratory, such as an N95, before entering the room of a patient with known or suspected tuberculosis or smallpox.

b) A fit-tested N95 or surgical mask may be appropriate for healthcare personnel to wear while caring for patients with known or suspected measles, chickenpox, or disseminated herpes zoster.

6) Patient transport

a) Limit transport and movement of patients outside of the room to medically-necessary purposes. b )If transport or movement outside an AIIR is necessary, instruct patients to wear a surgical mask, if possible, and observe Respiratory Hygiene/Cough Etiquette.

c) For patients with skin lesions associated with varicella or smallpox or draining skin lesions caused by M. tuberculosis, cover the affected areas to prevent aerosolization or contact with the infectious agent in skin lesions.

d) Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered.

7) Exposure management

a) Administer measles vaccine to exposed susceptible persons within 72 h after the exposure or administer immune globulin within six days of the exposure event for high-risk persons in whom vaccine is contraindicated.

b) Administer varicella vaccine to exposed susceptible persons within 120 h after the exposure or administer varicella immune globulin, when available, within 96 h for high-risk persons in whom vaccine is contraindicated (e.g., immunocompromised patients, 43 pregnant women, newborns whose mother’s varicella onset was <5 d before or within 48 h after delivery).

c) Administer smallpox vaccine to exposed susceptible persons within 4 days after exposure.