Isolation Precautions Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals Your taxes at work

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

Isolation Precaution System for Institutions is an expansion of Universal Precautions

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

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

Humans sheds # 300,000,000 squames/day (4 to 25 mm) able to carry bacteria What Does Handwashing Do? 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, perineal area,genitals, anal area catheter, bedpan, urinal, patient care casual contact May have high virulenceð Enterobacteria, Gram - bacilli, Pseudomonas...

Patient care Activity Seroytpe 21 Klebsiella cultured Hands of nurses washed and cultured: NO Klebsiella What Does Handwashing Do? ActivityNumber of Klebsiella on nurse’s hand In Colony Forming Units (CFU) Pulse, blood pressure100-1,000 Touching hand Touch shoulder7,0000 Oral temperature100 – 1,000 Caswell & PhillipsBritish Med J Nov 1977: 1316

Handwashing

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.

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

Eye Protection Face Shield RISK OF SPRAY or SPLASH of blood, body fluid, secretion excretion in FACE OR EYE

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)

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

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 immunocompromised patient with infected one

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

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

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

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

Respiratory Etiquette

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

1 Wash * Touch * Wash If red, wet or dirty Wash * Glove Touch Unglove * Wash Know what is clean Know what is dirty Keep them apart OK 3 2 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

AIRBORNE PRECAUTIONS Personal Respirator: N95 Room with Ventilation Control: Negative pressure > 6 air exchange Air filtrated before recirculation or vented outside CONTACT PRECAUTIONS Private room or 3ft separation between patients Gloves when entering Gown IF extensive contact DROPLET PRECAUTIONS Private room or 3ft separation between patients Mask when within 3 ft of patients Tuberculosis, Measles, Varicella, Any suspect of TB: chronic pulmonary symptoms >3 weeks 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) 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. Use STANDARD PRECAUTIONS WITH ALL PATIENTS ALL THE TIME And these other precautions may be added We do not use these terms any longer: Strict Isolation, Blood & body fluids,Drainage and secretions, Enteric, Respiratory, AFB A droplet ofwill fall in 100  m 10 seconds 40  m 1 minute 20  m 4 minutes 10  m 20 minutes 5-10  m minutes  5  m Droplet Nuclei Stay suspended for hours, travels far