ISOLATION UPDATE FOR NURSES

1. ISOLATION UPDATE FOR NURSES Department of Hospital Epidemiology and Infection Control 5-8384 Osler 425 www.hopkins-heic.org Updated 4/28/03

2. Infection epidemic carves deadly path Poor hygiene, overwhelmed workers contribute to thousands of deaths First of three parts. By Michael J. BerensTribune staff reporterJuly 21, 2002A hidden epidemic of life-threatening infections is contaminating America's hospitals, needlessly killing tens of thousands of patients each year.

3. Prevent infections by: • Practicing good hand hygiene • Following Standard Precautions and isolation instructions • Receiving vaccinations

4. Important Terms Colonizationis the presence of a pathogen in a body site without any clinical signs and symptoms. Different organisms prefer different body sites, e.g. MRSA prefers nares, VRE prefers GI tract. An infection occurs when there are clinical signs and symptoms (fever, erythema, edema, purulent drainage, etc.)

5. STANDARD PRECAUTIONS • Practiced for all patients • Keep a barrier between the HCW and the blood and/or body fluids of ALL patients • GLOVES • GOWNS • MASKS • EYEWEAR

6. Prevent Infections… ISOLATION

7. Isolation guidelines are based on the ways that specific organisms are spread In order to protect patients and staff, additional isolation categories are needed to supplement Standard Precautions Isolation

8. Follow Isolation Directions • Follow the isolation sign on patient door/bed space • Check patient’s chart for isolation sticker

9. What’s New for 2003? • Nurses now have the authority to initiate isolation through a nursing order • Strict Isolation has been discontinued • Patients previously placed in Strict Isolation will now require Airborne & Contact Precautions • Examples: Chickenpox, Disseminated Herpes Zoster, Smallpox, SARS

10. What Else is New? • Airborne Isolation room requirements • Negative pressure vented to the outside (suitable for TB) • Negative pressure room not vented to outside but with HEPA Filter may be used if no “TB” rooms are available • Initiation of Airborne Isolation requires ID approval (not new but now encompasses more diseases)

11. Still More New Information • Airborne Isolation requires the use of PAPR by HCW • HCW known to be immune to chickenpox, or measles do not need to wear PAPR when caring for patients with those diseases or disseminated Zoster • PAPR must be worn by all HCW when caring for patient with TB, Smallpox, SARS

12. Airborne Precautions Airborne precautions are required for: • Tuberculosis (TB), Smallpox, Chickenpox, Measles, SARS Requirements: • ID physician approval • Negative pressure room • Staff must wear Powered-Air Purifying Respirators (PAPRs) and close door behind them • Staff remove PAPR prior to exiting ante-room • Sanitize hands after leaving room

13. PAPRs • PAPRs are obtainable from Central Supply at x 5-8357 • Hoods can be reused by the same HCW • Be sure to obtain more than one or two • Call HSE at x 5-5918 to pick up units when no longer needed • HSE will also provide training about how to use the PAPR

14. Contact Precautions Contactisolation is required for: • MRSA, C. diff, Adenovirus, conjunctivitis, decubitus ulcer infection, etc. Requirements: • Gown and gloves for contact with patient in room • Remove gown and gloves prior to leaving room • Sanitize hands after leaving room

15. Special Precautions • Special Precautions are required for: • VRE, VISA • Requirements: • Private room • Visitors and Healthcare Worker (HCW) must don a gown and gloves before entering patient room • Sanitize hands after leaving room • Dispose of gown and gloves before leaving the room

16. Fingers and Fomites: VRE VRE (E faecium) can be recovered from gloved and ungloved fingertips for at least 60 minutes after inoculation VRE recovered from bedrails (Up to 24 Hours), telephones, and stethoscopes (Up to 60 Minutes) VRE recovered from countertops for up to 7 days after inoculation Noskin, ICHE: 1995;16:577-581.

17. VISA/VRSA VISA (Vancomycin Intermediate Staphylococcus aureus) • 1999- now 20 cases worldwide • Has not demonstrated transmission to health care workers VRSA (Vancomycin Resistant Staphylococcus aureus) • 2002- 2 cases in the United States • In both cases, patients were co-infected with MRSA/VRE

18. Droplet Precautions Dropletprecautions are required for: • Influenza, (adult) RSV, Parvovirus, Croup, Mumps, Pertussis, Strept throat, etc Requirements: • Mask, gown, gloves when within 3-6 feet of patient • Sanitize hands after leaving room

19. Pediatric Droplet • Specifically for the pediatric patient with Respiratory Syncytial Virus (RSV) • Private room preferred • Gowns and masks are required for contact • Protective attire must be removed before leaving the room • Hand hygiene must be performed after leaving the room

20. Transport of Patients Requiring Isolation • Should be limited to essential needs • Masking of patient with standard surgical mask if droplet or airborne transmission and the patient can tolerate • Notify receiving department of appropriate precautions • Make sure chart is appropriately labeled

21. What’s wrong with this picture?

22. JHH Coding Procedures • If a patient presents for admission to your unit, check his magenta plate to ensure isolation is not required. • ICO1 VRE “Special” • ICO2 MRSA “Contact” • ICO4 Varicella “Airborne, Contact” • ICO7 Both MRSA and VRE “Special” • ICO8 “Contact” for any Cystic Fibrosis patient with Burkholderia cepacia (will not be on the same floor as other cystic fibrosis patients)

23. Isolation Summary • Sometimes “Standard Precautions” are not enough • “Isolation Precautions” protects patients and staff from spreading communicable diseases • Follow isolation signs and instructions posted on patients doors • Isolation policy is available on-line at www.hopkins-heic.org for further information

24. Hand Hygiene: Best way to Prevent Infection