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ISOLATION PRECAUTION Dr.Saeed.kalantari.

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Presentation on theme: "ISOLATION PRECAUTION Dr.Saeed.kalantari."— Presentation transcript:

1 ISOLATION PRECAUTION Dr.Saeed.kalantari

2 Learning Objectives Discuss chain of infection and different types of mode of transmission Define isolation precautions and describe different types isolation precautions. Describe standard precautions procedures and conditions under which to use standard precautions Describe contact precautions and conditions under which to use contact precautions. Describe conditions under which to use droplet precautions. Describe conditions under which to use airborne precautions.

3 Chain of infection infectious diseases result from the interaction of agent, host, and environment. More specifically, transmission occurs when the agent leaves its reservoir or host through a portal of exit, is conveyed by some mode of transmission, and enters through an appropriate portal of entry to infect a susceptible host. This sequence is sometimes called the chain of infection. The reservoir of an infectious agent is the habitat in which the agent normally lives, grows, and multiplies. Reservoirs include humans, animals, and the environment. The reservoir may or may not be the source from which an agent is transferred to a host. Human reservoirs. Many common infectious diseases have human reservoirs. Diseases that are transmitted from person to person without intermediaries include the sexually transmitted diseases, measles, mumps, streptococcal infection, and many respiratory pathogens. Because humans were the only reservoir for the smallpox virus, naturally occurring smallpox was eradicated after the last human case was identified and isolated. Human reservoirs may or may not show the effects of illness. As noted earlier, a carrier is a person with inapparent infection who is capable of transmitting the pathogen to others. Asymptomatic or passive or healthy carriers are those who never experience symptoms despite being infected.

4 Mode of transmission A microorganism may be spread by a single or multiple routes. Contact, direct or indirect Droplet Airborne Vector-borne (usually arthropod) and Common environmental sources or vehicles - includes food-borne and waterborne, medications e.g., contaminated IV fluids Several main routes of transmission of microorganisms. A microorganism may be spread by a single or multiple routes. Types of mode of transmission: Contact, direct or indirect Droplet Airborne Vectorborne (usually arthropod) and Common environmental sources or vehicles - includes foodborne and waterborne, medications e.g., contaminated IV fluids

5 Contact transmission Direct-contact
Direct body surface-to-body surface contact and Physical transfer of microorganisms between a susceptible host and an infected or colonized person Indirect-contact Contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands or gloves The most important and frequent mode of transmission of nosocomial infection Two subgroups: Direct-contact Direct body surface-to-body surface contact and Physical transfer of microorganisms between a susceptible host and an infected or colonized person Indirect-contact Contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands or gloves

6 droplet transmission Droplet generation Droplet transmission
coughing, sneezing, talking, procedures such as suctioning and bronchoscopy Droplet transmission Droplet deposited on the host’s conjunctivae, nasal mucosa, or mouth. Droplets – generated from the source person primarily during coughing, sneezing, and talking, and during the performance of certain procedures such as suctioning and bronchoscopy Droplet transmission occurs when droplets containing microorganisms generated from the infected person are propelled a short distance through the air and deposited on the host’s conjunctivae, nasal mucosa, or mouth.

7 Airborne transmission
Small-particle residue {5µm or smaller} of evaporated droplets containing microorganisms Suspended in the air for long periods of time Dispersed by air currents Inhaled by a susceptible host within the same room or over a longer distance Occurs by dissemination of either airborne droplet nuclei (small-particle residue {5µm or smaller in size) of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent Microorganisms can be dispersed by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environment factors Therefore, special air handling and ventilation are required to prevent airborne transmission. E.g. Mycobactarium tuberculosis and the rubeola and varicella viruses

8 Definition of Isolation Precautions
Special precautionary measures, practices, and procedures used in the care of patients with contagious or communicable diseases

9 Fundamentals of isolation precautions
Handwashing and gloving Personal protective equipments: Masks, respiratory protection, eye protection, face shields, gowns Patient-care equipment and articles Linen and laundry Routine and terminal cleaning Patient placement Transport of infected patients

10 Isolation Precautions
Unit 6 - Infection Control Measures Isolation Precautions Hand hygiene Patient placement PPE Isolation Precautions Patient Transport Routine and Terminal Cleaning In HA hospitals, isolation precautions should be implemented to break the transmission of infections. The elements includes hand hygiene, PPE, patient placement, decontamination, waste management, linen and laundry, and patient transport. Each of them will be discussed in the following presentation. Reference: HA Infection Control Plan for Avian Influenza Jul 2006 Linen & laundry Patient care equipment And articles Unit 6 - Infection Control Measures

11 Types of Isolation Precautions
Standard precautions Transmission-based precautions Contact precautions Airborne precautions Droplet precautions

12 Definition of standard precautions
Apply to all patients receiving care in hospitals regardless of their diagnosis or presumed infection status. Apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4) mucous membranes. Designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals. Apply to all patients receiving care in hospitals regardless of their diagnosis or presumed infection status. Apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) nonintact skin; and (4) mucous membranes.

13 Standard Precaution - Hand hygiene
Handwashing with either plain or antiseptic containing soap and water, and use of alcohol-based products (gels, rinses, foams) that do not requre the use of water Perform hand hygiene: Before and after patient contact After removing gloves or any other PPE item After touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn Handwashing is the single most important procedure for preventing the spread of communicable diseases. Perform hand hygiene: Before and after patient contact After removing gloves or any other PPE item After touching blood, body fluids, secretions, excretions, and contaminated items, whether or not gloves are worn 2. Improved hand hygiene practices associated with a sustained decrease of MRSA and VRE infections primarily in ICU. Unit 6 - Infection Control Measures

14 Standard precautions – Gloves (PPE)
Exposure to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin, and contaminated items Change gloves when heavily contaminated Perform hand hygiene immediately after glove removal Personal Protective Equipment - Gloves The primary design of personal protective equipment (PPE) is to protect healthcare workers (HCWs) and reduce opportunities for transmission of microorganisms in Healthcare facilities. Gloves Wear gloves when the procedure may expose you to blood, body fluids, secretions, excretions, mucous membrane and non-intact skin, and contaminated items Change gloves after contact with material that may contain a high concentration of microorganisms, e.g. it may happen between tasks and procedures on the same patient Wash hands immediately after gloves are removed. Do not disinfect clean gloves after donning and disposable gloves should not be reused References: Centers for Disease Control and Prevention. (1996). Guidelines for Isolation Precautions in Hospitals Hospital Infection Control Advisory Committee. Retrieved September 30, 2006, from HA Infection Control Plan for Avian Influenza Jul 2006 4. Disposable glove should not be reused Unit 6 - Infection Control Measures

15 Standard precautions – Mask and eye protection (PPE)
Surgical masks and eye protection: When splashes or sprays of blood and body fluid, secretions and excretions are likely Sterile technique Respiratory etiquette Change PPE promptly if heavily contaminated during the procedure Personal Protective Equipment – Mask & eye protection Masks are used for 3 primary purposes in healthcare facilities: Placed on HCW to protect them from contact with infectious material from patients e.g., resp. secretions and sprays of blood or body fluids, consistent with Standard precautions Placed on HCW when engaged in procedures requiring sterile technique to protect patients from exposure to infectious agents carried in a HCW’s mouth or nose. Placed on coughing patients to limit potential dissemination of infectious resp. secretions from patient to others. Surgical masks and eye protection: Wear surgical mask and eye protection or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood and body fluids, secretions and excretions are likely .Health care workers should change PPE promptly if it is heavily contaminated during the procedure. Unit 6 - Infection Control Measures

16 Standard precautions - prevent hcws exposure to bloodborne pathogens
Prevent needles and other sharps instrument injuries Prevent mucous membrane exposures Safe work practices and PPE to protect mucous membranes and non-intact skin Needles and other sharps instrument injuries associated with transmission of HBV, HCV, HIV to HCW Prevention of mucous membrane exposures has been an element of standard precautions for routine patient care Safe work practices and wear PPE to protect mucous membranes and non-intact skin from contact with potentially infectious material.

17 TRANSMISSION-BASED PRECAUTIONS

18 TRANSMISSION-BASED PRECAUTIONS - Patient Placement
Single patient rooms - always indicated for patients placed on airborne precautions and preferable for those who require contact of droplet precautions Cohort patients with same organism Unit 6 - Infection Control Measures

19 TRANSMISSION-BASED PRECAUTIONS - Contact Precautions
Infections spread by direct or indirect contact with patients or patient-care environment – shigellosis, C. difficle, MRSA Limit patient movement Private/SINGLE room or cohort with patients with same infection Wear disposable gown and gloves when entering the patient room Remove and discard used disposable gown and gloves inside the patient room Wash hands immediately after leaving the patient room Clean patient room daily using a hospital disinfectant, with attention to frequently touched surfaces (bed rails, bedside tables, lavatory surfaces, blood pressure cuff, equipment surfaces) Use dedicated equipment if possible (e.g., stethoscope) TRANSMISSION-BASED PRECAUTIONS - Contact Precautions Consists of standard precautions (see previous frames) plus precautions for direct and indirect contact Infections spread by direct or indirect contact with patients or patient-care environment – shigellosis, C. difficle, MRSA Limit patient movement Private room or room shared with patients with same infection status Wear disposable gown and gloves when entering the patient room Remove and discard used disposable gown and gloves inside the patient room Wash hands immediately after leaving the patient room Clean patient room daily using a hospital disinfectant, with attention to frequently touched surfaces (bed rails, bedside tables, lavatory surfaces, blood pressure cuff, equipment surfaces) Use dedicated equipment if possible (e.g., stethoscope)

20 Contact Precautions cont.
GLOVES Use gloves when entering the room. Change gloves after contact with infective material. Remove gloves before leaving the room. Wash hands or use appropriate gel after glove removal. Do not touch infective material or surfaces with hands. Clean, non-sterile gloves are usually adequate. GOWN Use protective gown when entering the room if direct contact with patient or potentially contaminated surfaces or equipment near patient is anticipated or if the patient has diarrhea or colostomy or wound drainage that is not covered by a dressing. GLOVES Use gloves when entering the room. Change gloves after contact with infective material. Remove gloves before leaving the room. Wash hands or use appropriate gel after glove removal. Do not touch infective material or surfaces with hands. Clean, non-sterile gloves are usually adequate. GOWN Use protective gown when entering the room if direct contact with patient or potentially contaminated surfaces or equipment near patient is anticipated or if the patient has diarrhea or colostomy or wound drainage that is not covered by a dressing. Remove gown and observe hand hygiene prior to leaving room, and do not come in contact with potentially contaminated environmental surfaces

21 Contact precautions signs

22 Droplet Precautions Reduce the risk of transmission by large particle droplets (larger than 5 m in size). Requires close contact between the source person and the recipient Droplets usually travel 3 feet or less E.g., influenza, rubella, parvovirus B19, mumps, H. influenzae, and N. meningitidis Consists of standard precautions plus specifics for droplet precautions Ues to reduce the risk of transmission of microorganisms transmitted by large particle droplets (larger than 5 m in size). Droplet transmission requires close contact between the source person and the recipient because droplets do not remain suspended in the air. Droplets usually travel 3 feet or less within the air and thus special air handling is not required. Droplet transmission involves contact of the conjunctiva of the eyes or the mucous membranes of the nose or mouth of a person with the microorganism generated from the infected source person during coughing, sneezing or talking, or during the performance of procedures such as suctioning and bronchoscopy.

23 Droplet Precautions cont.
A private/single room or Cohort with patient with active infection with same microorganism Use a mask when entering the room and definitely if within 3 feet of patient Limit movement and transport of the patient. Use a mask on the patient if they need to be moved and follow respiratory hygiene/cough etiquette Keep at least 3 feet between infected patient and visitors Place the patient in a private/single room or if not available Cohort with patient with active infection with same microorganism Use of respiratory protection such as a mask when entering the room recommended and definitely if within 3 feet of patient Limit movement and transport of the patient. Use a mask on the patient if they need to be moved and follow repiratory hygiene/cough etiquette Keep patient at least 3 feet apart between infected patient and visitors Room door may remain open

24 Droplet precautions signs

25 Airborne Precautions Tuberculosis, measles, varicella
Place the patient in an airborne infection isolation room (AIIR) Pressure should be monitored with visible indicator Use of respiratory protection (e.g., fit tested N95 respirator) Limit movement and transport of the patient. Use a mask on the patient if they need to be moved Keep patient room door closed.

26 Airborne precautions signs

27 Terminology Cleaning general removal of debris (dirt, food, feces, blood, saliva and other body secretions).reduces amount of organic matter that contributes to proliferation of bacteria and viruses Disinfection removes most organisms present on surfaces that can cause infection or disease Sterilization the killing or removal of all organisms

28 Spaulding Classification

29 Critical Semicritical Noncritical

30 Resistance of Microorganisms
Sterilization Spores bacterial, fungal Bacillus stearothermophilus Bacillus subtilis Clostridium sporogenes High Level Disinfection Mycobacteria, TB bacilli Intermediate Disinfection Hydrophilic viruses Polio, Coxsackie, Rhino Low Disinfection Vegetative fungi & bacteria Lipophilic viruses Trichophyton, Cryptococcus,Candida Pseudomonas, Staphylococcus,Salmonella HSV, CMV, RSV, HBV, HIV

31 ضد عفونی کننده های high level:
پراکسید هیدروژن پراستیک اسید گلوتارالدهید فرمالدهید

32 ضد عفونی کننده های intermediate level:
کلر و ترکیبات کلره ید و ترکیبات یده الکل ها

33 ضد عفونی کننده های low level:
فنل و ترکیبات فنلی ترکیبات آمونیوم

34 Resistance of Microorganisms
Sterilization Spores bacterial, fungal Bacillus stearothermophilus Bacillus subtilis Clostridium sporogenes High Level Disinfection Mycobacteria, TB bacilli Intermediate Disinfection Hydrophilic viruses Polio, Coxsackie, Rhino Low Disinfection Vegetative fungi & bacteria Lipophilic viruses Trichophyton, Cryptococcus,Candida Pseudomonas, Staphylococcus,Salmonella HSV, CMV, RSV, HBV, HIV

35 Ultraviolet Radiation
Dependent on strength and duration of exposure to light, line of sight‟, how well microorganism can withstand UV imited to destruction of airborne organisms, inactivation of microorganisms on surfaces, and water purification

36 References 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings: CDC guidelines for isolation precautions in hospitals 1996, Hospital Infection Control Practices Advisory Committee (HICPAC): Principles of Epidemiology in public health practice, 3rd edition


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