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Isolation Precautions

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  1. IsolationPrecautions Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals 800-256-2748 Your taxes at work

  2. Main Modes of Transmission Isolation guidelines in Institutions are based on these AIRBORNE DROPLET AND Vectorborne, Common source: Water, Food, Equipment, Rx CONTACT Direct Indirect

  3. Isolation Precaution System for Institutions is an expansion of Universal Precautions Standard Precautions

  4. Standard Precautions • Same concept as UNIVERSAL PRECAUTIONS • Precautions should be taken for any contact with Blood and Body Fluid (UP) • AND for any contact with secretions and excretions, mucous membranes, damaged skin, contaminated environment and equipment

  5. Handwashing • Beginning and end of day • Before & after each patient contact • Before and after gloving • Anytime after contact with • Blood & body fluid • Secretions /excretions • Mucous membranes • Damaged skin • Contaminated environment • Contaminated equipment 10-15s

  6. RESIDENT FLORA Survives on the skin more than 24 hours Not easily removed, hours of scrubbing Complete stelirization impossible Low virulence Staphylococci, diphteroides, mostly Gram + , very few Gram - TRANSIENT FLORA Survive on skin less than 24 hours Easily removed with soap and water Acquired during contacts with contaminated areas mouth, nose, perinealarea,genitals, anal area catheter, bedpan, urinal, patient care casual contact May have high virulenceðEnterobacteria, Gram - bacilli, Pseudomonas... What Does Handwashing Do? Humans sheds # 300,000,000 squames/day (4 to 25 mm) able to carry bacteria

  7. What Does Handwashing Do? Hands of nurses washed and cultured: NO Klebsiella Seroytpe 21 Klebsiella cultured Patient care Activity

  8. Handwashing

  9. Hand Sanitizer • Washing hands with soap and water is the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, • but sanitizers do not eliminate all types of germs: Not effective on spores (particularly Clostridium difficile)  • Hand sanitizers are not effective when hands are visibly dirty.

  10. Gloves GLOVES DO NOT REPLACE HANDWASHING FOR ANY CONTACT WITH • Blood and Body Fluids • Secretions & excretions • Mucous membranes • Damaged skin • Contaminated environment or equipment If it is wet, red or dirty Wash, glove then wash

  11. Eye ProtectionFace Shield RISK OF SPRAY or SPLASH • of blood, • body fluid, • secretion • excretion in FACE OR EYE

  12. Surgical Masks • STANDARD PRECAUTIONS For personnel to protect from splashes /sprays of BBF/ S E • DROPLET PRECAUTIONS to prevent large droplets (>5m) on/from patient • For patients to prevent emission of droplet (large and droplet nuclei)

  13. Gown • STANDARD PRECAUTION To protect from splashes /sprays of large quantities of BBF/S E • CONTACT PRECAUTION To protect contamination of personnel clothing

  14. Patient Placement • AIRBORNE Private room with ventilation control • DROPLET & CONTACT • Private room preferred • or cohort with same infection • or at least 3 feet between beds • Use common sense: do not mix in immunocompromisedpatient with infected one

  15. Airborne Precautions Small droplets (<5m) emitted when coughing, & performance of procedures 1-ROOM WITH VENTILATION CONTROL • Negative air pressure • >6 air exchange /hour • HEPA filtered or exshaustout 2-PERSONAL RESPIRATOR 3-PATIENT wears surgical mask if coughing & when transported Use STANDARD PRECAUTIONS at ALL times for ALL patients

  16. Airborne Precautions: Personal Respirator For Personnel • In AIRBORNE ISOLATION ONLY • To prevent inhalation of droplet nuclei • Main leak comes from poor fit around face N95 Mask PAPR Powered Air Purifying Respirators Use STANDARD PRECAUTIONS at ALL times for ALL patients

  17. Airborne Precautions: Signage Use STANDARD PRECAUTIONS at ALL times for ALL patients

  18. Droplet Precautions Large particle droplets (>5m) emitted when coughing, sneezing, talking & performance of procedures • Private room • Mask when entering room Use STANDARD PRECAUTIONS at ALL times for ALL patients

  19. Respiratory Etiquette

  20. Contact Precautions • Private room (*) • Gloves when entering room, • change glove after infectious contact • Gown when entering room if substantial contact will occur Use STANDARD PRECAUTIONS at ALL times for ALL patients

  21. Standard Precaution: Ridiculously Simple STANDARD PRECAUTIONS = Universal precautions: Any one may be infectious, there is no way of predicting who is infected and may transmit blood borne pathogens (HBV, HCV, HIV…) or other microorganisms (MRSA, Cdiff, MDRO…)  USE STANDARD PRECAUTIONS WITH ALL PATIENTS ALL THE TIME Wash * Touch * Wash 1 OK If red, wet or dirty Wash * Glove Touch Unglove * Wash 2 3 Know what is clean Know what is dirty Keep them apart

  22. Use STANDARD PRECAUTIONS WITH ALL PATIENTS ALL THE TIME And these other precautions may be added • AIRBORNE PRECAUTIONS • Personal Respirator: N95 • Room with Ventilation Control: • Negative pressure • > 6 air exchange • Air filtrated before recirculation • or vented outside Tuberculosis, Measles, Varicella, Any suspect of TB: chronic pulmonary symptoms >3 weeks • DROPLET PRECAUTIONS • Private room or 3ft separation between patients • Mask when within 3 ft of patients MOST BACTERIAL & VIRAL RESPIRATORY INFECTIONS except RSV Invasive H.influenzae, N.meningitidis, Invasive drug resistant S.pneumoniae, All serious bacterial respiratory infections spread by droplets, Diphtheria, Pneumonic Plague, Pertussis, Mycoplasma pneumoniae, Streptococcal pharyngitis, streptococcal pneumonia, scarlet fever, Adenoviral infections, Influenza, Mumps, Parvovirus 19, Rubella, Paroxysmal cough (?Pertussis) • CONTACT PRECAUTIONS • Private room or 3ft separation between patients • Gloves when entering • Gown IF extensive contact INFECTIONS TRANSMITTED BY CONTACT Multi-Drug Resistant Organisms (MDRO), gastrointestinal, respiratory, skin, wound, infections or colonization with multidrug resistant bacteria, Enteric infections, enteroviral infections in infant, RSV, parainfluenza, Infectious skin infections: HSV, impetigo, cellulitis, scabies, staphylococcal furunculosis,Viral hemorrhagic conjunctivitis, viral fevers, abscess, draining wounds that cannot be covered. Respiratory infections: bronchiolitis in infants & children. We do not use these terms any longer: Strict Isolation, Blood & body fluids,Drainage and secretions, Enteric, Respiratory, AFB